Individual
DANA PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
375 APPLE TREE DR, IONIA, MI 48846-7506
(616) 527-1790
Mailing address
375 APPLE TREE DR, IONIA, MI 48846-7506
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801100200
MI
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1715928
—
MI
Enumeration date
11/29/2017
Last updated
01/22/2019
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