=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043190119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMA VAWTER LLMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6960 ORCHARD LAKE RD
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-4515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-693-5543
-----------------------------------------------------
Fax | 248-221-1775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3071 SEYMOUR LAKE RD
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48371-4250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-705-6315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6851120929
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------