MEDICARE: MRS. KELLY WILSON LLMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6851118246	MI

General Provider Information

NPI Number	:	1073335881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY WILSON LLMSW

Provider Business Mailing Address
First Line	:	4071 MORNINGVIEW DR
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-3925
Country	:	US
Telephone Number	:	586-291-4695
Fax Number	:

Provider Business Practice Location Address
First Line	:	39600 GARFIELD RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-5913
Country	:	US
Telephone Number	:	586-291-4695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

Similar Medicare Providers

1972144855 — TRACI RIZZO MSN, PMHNP-BC
Practice Location Address:

39600 GARFIELD RD STE F
CLINTON TWP, MI
48038-5913

Practice Phone: 734-600-7873
Practice Fax:

1245091487 — BRITTANY THELEN PA-C
Practice Location Address:

39600 GARFIELD RD STE F
CLINTON TWP, MI
48038-5913

Practice Phone: 734-600-7873
Practice Fax: 586-307-6577

1114705191 — RUEDA ABDIRAHMAN MSW
Practice Location Address:

39600 GARFIELD RD
CLINTON TOWNSHIP, MI
48038-5913

Practice Phone: 734-600-7873
Practice Fax:

1730990623 — BRITTANY COLEMAN RN
Practice Location Address:

39600 GARFIELD RD STE F
CLINTON TOWNSHIP, MI
48038-5913

Practice Phone: 734-600-7873
Practice Fax:

1205602026 — SAKINA DEVEREAUX
Practice Location Address:

5573 WOODMANSEE WAY
LIBERTY TWP, OH
45011-5913

Practice Phone: 513-364-4264
Practice Fax:

1427337534 — NIHIT GUPTA M.D.
Practice Location Address:

5913 STONES THROW WAY
LIBERTY TWP, OH
45044-1505

Practice Phone: 814-591-7902
Practice Fax:

Directions to “ MRS. KELLY WILSON LLMSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.