Individual
MS. AGNES ANNE BISSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1209 RICHARDSON ST, PORT HURON, MI 48060-3548
(810) 984-5156
Mailing address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 985-2614
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
643729
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M85900
MEDICARE GROUP PTAN
—
01
—
M85900021
MEDICARE PTAN
—
Enumeration date
02/09/2007
Last updated
09/02/2008
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