Healthcare Provider Details

I. General information

NPI: 1528374907
Provider Name (Legal Business Name): NANCY JEAN WILLIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY JEAN WILSON LMSW

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 JACKSON RD STE D
ANN ARBOR MI
48103-1867
US

IV. Provider business mailing address

5060 JACKSON RD STE D
ANN ARBOR MI
48103-1867
US

V. Phone/Fax

Practice location:
  • Phone: 734-627-8001
  • Fax: 734-433-1989
Mailing address:
  • Phone: 734-627-8001
  • Fax: 734-433-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117431
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-07172
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number081889-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: