Healthcare Provider Details

I. General information

NPI: 1174863823
Provider Name (Legal Business Name): NAOMI ZIKMUND-FISHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 WASHTENAW RD UPPR LEVEL
YPSILANTI MI
48197-1889
US

IV. Provider business mailing address

2048 WASHTENAW RD UPPR LEVEL
YPSILANTI MI
48197-1889
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-0938
  • Fax:
Mailing address:
  • Phone: 517-879-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801094347
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: