Tessa L Dagenais, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801094473 Issued in MI

Practice address

601 W Superior St
Munising, MI 49862-1328

Phone

(906) 233-1322

Fax

(906) 233-1220

NPI assigned

Sep 25, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tessa L Mattson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1174874572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W SUPERIOR ST",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621328",
            "telephone_number": "906-233-1322",
            "fax_number": "906-233-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W SUPERIOR ST",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621328",
            "telephone_number": "906-233-1322",
            "fax_number": "906-233-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGENAIS",
        "first_name": "TESSA",
        "middle_name": "L",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801094473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TESSA",
            "last_name": "MATTSON",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Munising, MI
• Providers in Munising, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.