MEDICARE: THERESA WINDHAM LMSW

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	104100000X	Social Worker	6801098797	MI
2	1041C0700X	Clinical Social Worker	6801098797	MI

General Provider Information

NPI Number	:	1841657772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA WINDHAM LMSW

Provider Business Mailing Address
First Line	:	1011 WHITNEY ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 SPRING ARBOR RD STE D
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3663
Country	:	US
Telephone Number	:	517-798-5555
Fax Number	:

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

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	05/28/2026

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