Healthcare Provider Details

I. General information

NPI: 1669389292
Provider Name (Legal Business Name): MADELINE GO LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S RAISINVILLE RD
MONROE MI
48161-9047
US

IV. Provider business mailing address

3160 FERNWOOD AVE
ANN ARBOR MI
48108-1956
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-5799
  • Fax:
Mailing address:
  • Phone: 734-322-2745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851119407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: