Healthcare Provider Details

I. General information

NPI: 1174434468
Provider Name (Legal Business Name): JODY LYNN OBRYAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 DAN HOEY RD
DEXTER MI
48130-9836
US

IV. Provider business mailing address

2464 ARROWWOOD TRL
ANN ARBOR MI
48105-1210
US

V. Phone/Fax

Practice location:
  • Phone: 734-424-4120
  • Fax:
Mailing address:
  • Phone: 734-424-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801090351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: