Healthcare Provider Details

I. General information

NPI: 1932017670
Provider Name (Legal Business Name): STEPHANIE WISEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CASS LAKE RD
WATERFORD MI
48328-2307
US

IV. Provider business mailing address

8925 GLASGOW DR
WHITE LAKE MI
48386-3316
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-7837
  • Fax:
Mailing address:
  • Phone: 248-618-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801099445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: