Provider Demographics
NPI:1730869058
Name:LOONSFOOT, FAWN MARIE
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:MARIE
Last Name:LOONSFOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SANBORN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1769
Mailing Address - Country:US
Mailing Address - Phone:231-580-8482
Mailing Address - Fax:
Practice Address - Street 1:110 SANBORN AVE STE B
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1769
Practice Address - Country:US
Practice Address - Phone:231-580-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical