Healthcare Provider Details

I. General information

NPI: 1003922501
Provider Name (Legal Business Name): LISA INOUE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 PLYMOUTH RD STE 210
ANN ARBOR MI
48105-9559
US

IV. Provider business mailing address

5331 PLYMOUTH RD
ANN ARBOR MI
48105-9520
US

V. Phone/Fax

Practice location:
  • Phone: 734-707-1013
  • Fax: 734-345-1012
Mailing address:
  • Phone: 734-996-9111
  • Fax: 734-996-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: