MEDICARE: MRS. ANNETTE MARIE WELLS

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	6801117768	MI

General Provider Information

NPI Number	:	1437738119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE MARIE WELLS

Provider Business Mailing Address
First Line	:	47080 HIDDEN RIVER CIR N
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6313
Country	:	US
Telephone Number	:	805-368-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	40315 MICHIGAN AVE STE 1163
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2908
Country	:	US
Telephone Number	:	734-331-0463
Fax Number	:

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

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	08/21/2025

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