Healthcare Provider Details

I. General information

NPI: 1639091267
Provider Name (Legal Business Name): WASSERMAN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 202
ROCHESTER HILLS MI
48309-1779
US

IV. Provider business mailing address

1460 WALTON BLVD STE 202
ROCHESTER HILLS MI
48309-1779
US

V. Phone/Fax

Practice location:
  • Phone: 947-285-1219
  • Fax: 947-237-4408
Mailing address:
  • Phone: 947-285-1219
  • Fax: 947-237-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JILL WASSERMAN
Title or Position: OWNER
Credential: LPC
Phone: 947-285-1219