Healthcare Provider Details

I. General information

NPI: 1467835207
Provider Name (Legal Business Name): ANN MARIE WIMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3489 PALMER DR
SAUGATUCK MI
49453-9461
US

IV. Provider business mailing address

3489 PALMER DR
SAUGATUCK MI
49453-9461
US

V. Phone/Fax

Practice location:
  • Phone: 616-416-4030
  • Fax:
Mailing address:
  • Phone: 616-416-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW70907
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680110960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: