Provider Demographics
NPI:1104951938
Name:LITZNER, REBECCA N (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:LITZNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:N
Other - Last Name:TITUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49746-0427
Mailing Address - Country:US
Mailing Address - Phone:989-354-2197
Mailing Address - Fax:989-356-6524
Practice Address - Street 1:15774 STATE STREET
Practice Address - Street 2:
Practice Address - City:HILLMAN
Practice Address - State:MI
Practice Address - Zip Code:49746-0427
Practice Address - Country:US
Practice Address - Phone:989-742-4583
Practice Address - Fax:989-742-2183
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010843501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF06016079Medicare PIN