Healthcare Provider Details

I. General information

NPI: 1447524848
Provider Name (Legal Business Name): LINDA A HAYWOOD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35420 JOHN ST # 1046
WAYNE MI
48184-2362
US

IV. Provider business mailing address

40315 MICHIGAN AVE # 1046
CANTON MI
48188-2908
US

V. Phone/Fax

Practice location:
  • Phone: 734-444-7579
  • Fax:
Mailing address:
  • Phone: 734-799-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088635
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801088635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: