Provider Demographics
NPI:1962553453
Name:CEDAR TREE
Entity type:Organization
Organization Name:CEDAR TREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW ACSW
Authorized Official - Phone:906-228-5494
Mailing Address - Street 1:403 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3827
Mailing Address - Country:US
Mailing Address - Phone:906-228-5494
Mailing Address - Fax:906-228-5494
Practice Address - Street 1:403 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3827
Practice Address - Country:US
Practice Address - Phone:906-228-5494
Practice Address - Fax:906-228-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010702891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1245299601OtherDIRECTORS NPI NUMBER