MEDICARE: AUJENIQUE MONAE WILLIS

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	6801120109	MI

General Provider Information

NPI Number	:	1285394106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUJENIQUE MONAE WILLIS

Provider Business Mailing Address
First Line	:	18726 S WESTERN AVE
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3813
Country	:	US
Telephone Number	:	310-856-0800
Fax Number	:	855-568-2494

Provider Business Practice Location Address
First Line	:	22000 W 9 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033
Country	:	US
Telephone Number	:	248-372-5062
Fax Number	:

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

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	06/29/2026

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Directions to “ AUJENIQUE MONAE WILLIS ” Practice Location

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