MEDICARE: ISHAH AHMED LMSW

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	6801121790	MI

General Provider Information

NPI Number	:	1134941305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHAH AHMED LMSW

Provider Business Mailing Address
First Line	:	14930 LAPLAISANCE RD STE 106
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48161-3871
Country	:	US
Telephone Number	:	734-241-0180
Fax Number	:

Provider Business Practice Location Address
First Line	:	14930 LAPLAISANCE RD STE 106
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48161-3871
Country	:	US
Telephone Number	:	734-241-0180
Fax Number	:

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

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	03/09/2026

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