Healthcare Provider Details

I. General information

NPI: 1316430549
Provider Name (Legal Business Name): WAI-IAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N SYCAMORE ST
LANSING MI
48933-1033
US

IV. Provider business mailing address

217 N SYCAMORE ST
LANSING MI
48933-1033
US

V. Phone/Fax

Practice location:
  • Phone: 517-897-9001
  • Fax: 517-580-7128
Mailing address:
  • Phone: 517-897-9001
  • Fax: 517-580-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801096160
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801096160
License Number StateMI

VIII. Authorized Official

Name: JACQUELYN LIEBNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 517-897-9001