Healthcare Provider Details

I. General information

NPI: 1902156888
Provider Name (Legal Business Name): JILL HANNA WASSERMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 11/13/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SQUIRREL RD STE 315
AUBURN HILLS MI
48326-4608
US

IV. Provider business mailing address

2251 N. SQUIRREL STE 315
SHELBY TOWNSHIP MI
48315-6033
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0784
  • Fax:
Mailing address:
  • Phone: 586-566-3020
  • Fax: 586-566-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: