Provider Demographics
NPI:1588148928
Name:BIRDSALL, ANNA LUNA (LLBSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LUNA
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9003
Mailing Address - Country:US
Mailing Address - Phone:269-547-3887
Mailing Address - Fax:269-373-2939
Practice Address - Street 1:1608 LAKE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3170
Practice Address - Country:US
Practice Address - Phone:269-344-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802089304104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker