Healthcare Provider Details

I. General information

NPI: 1932385481
Provider Name (Legal Business Name): JAMILA A WEATHERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOK RD
GROSSE POINTE WOODS MI
48236-2713
US

IV. Provider business mailing address

15700 GRANDVILLE AVE
DETROIT MI
48223-1713
US

V. Phone/Fax

Practice location:
  • Phone: 313-886-0800
  • Fax:
Mailing address:
  • Phone: 313-595-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: