Healthcare Provider Details

I. General information

NPI: 1134941305
Provider Name (Legal Business Name): ISHAH AHMED MA, LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14930 LAPLAISANCE RD STE 106
MONROE MI
48161-3871
US

IV. Provider business mailing address

14930 LAPLAISANCE RD STE 106
MONROE MI
48161-3871
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-0180
  • Fax:
Mailing address:
  • Phone: 734-241-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117781
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: