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General NPI Number Information
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NPI Number | 1508596206
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Entity Type | Individual
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Provider Name | TANNER SCHUDLICH LMSW-C
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Gender | Male
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 120 E LIBERTY ST STE 215
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City | ANN ARBOR
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State | MI
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Zip | 48104-2156
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Country | US
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Telephone | 734-489-9475
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Fax |
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Provider Business Mailing Address
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Address Line | 9862 CAMBRIDGE PL
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City | YPSILANTI
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State | MI
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Zip | 48198-3692
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Country | US
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Telephone | 586-817-4024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801118354
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License Number State | MI
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