MEDICARE: MR. WILLIAM DALE WHITING SR. MA SW

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	6801063160	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164481701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM DALE WHITING SR. MA SW

Provider Business Mailing Address
First Line	:	3962 WADHAMS RD
Second Line	:
City	:	CHINA TWP
State	:	MI
Zip	:	48054
Country	:	US
Telephone Number	:	810-329-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 N RIVER RD
Second Line	:
City	:	ST CLAIR
State	:	MI
Zip	:	48079
Country	:	US
Telephone Number	:	810-329-4798
Fax Number	:	810-329-7303

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/19/2010

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Directions to “ MR. WILLIAM DALE WHITING SR. MA SW” Practice Location

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