Healthcare Provider Details

I. General information

NPI: 1336004589
Provider Name (Legal Business Name): ALICE ANN WALTERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 TELEGRAPH RD STE 9329
REDFORD MI
48239-1260
US

IV. Provider business mailing address

18264 DENBY
REDFORD MI
48240-2001
US

V. Phone/Fax

Practice location:
  • Phone: 313-937-9500
  • Fax:
Mailing address:
  • Phone: 313-333-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801057070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: