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NPI Code Detail

MEDICARE: TANESHA LYNN WILSON

MEDICARE: TANESHA LYNN WILSON
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1770471534
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANESHA LYNN WILSON
Provider Business Mailing Address
First Line : 5200 STECKER ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-3813
Country : US
Telephone Number : 313-443-2416
Fax Number :
Provider Business Practice Location Address
First Line : 5200 STECKER ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-3813
Country : US
Telephone Number : 313-443-2416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2025
Last Update Date : 06/27/2025

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Directions to “ TANESHA LYNN WILSON ” Practice Location

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