Healthcare Provider Details

I. General information

NPI: 1801334107
Provider Name (Legal Business Name): WENDOLYN ANDERSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S MAIN ST STE 6
PLYMOUTH MI
48170-1778
US

IV. Provider business mailing address

575 S MAIN ST STE 6
PLYMOUTH MI
48170-1778
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-7800
  • Fax: 734-451-5410
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: