Provider Demographics
NPI:1720494875
Name:MCHATTIE, MARGO LYNN
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:LYNN
Last Name:MCHATTIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:MCHATTIE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2615 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1654
Mailing Address - Country:US
Mailing Address - Phone:269-343-1651
Mailing Address - Fax:269-382-7078
Practice Address - Street 1:2615 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1654
Practice Address - Country:US
Practice Address - Phone:269-343-1651
Practice Address - Fax:269-382-7078
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0390172104100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker