MEDICARE: WENDY MICHELLE DAVIS BSW, LLMSW

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	6851115599	MI

General Provider Information

NPI Number	:	1790585404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY MICHELLE DAVIS BSW, LLMSW

Provider Business Mailing Address
First Line	:	110 EASTERN ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1187
Country	:	US
Telephone Number	:	313-570-7088
Fax Number	:

Provider Business Practice Location Address
First Line	:	22511 TELEGRAPH RD STE 222
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-4108
Country	:	US
Telephone Number	:	248-598-2297
Fax Number	:

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

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/13/2025

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