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General NPI Number Information
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NPI Number | 1811871171
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Entity Type | Individual
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Provider Name | JASON WILBUR KIDWELL LLMSW
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Gender |
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 2301 S HURON PKWY STE 2B
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City | ANN ARBOR
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State | MI
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Zip | 48104-5133
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Country | US
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Telephone | 734-725-8802
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Fax |
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Provider Business Mailing Address
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Address Line | 3560 BARRY ST
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City | WAYNE
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State | MI
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Zip | 48184-1904
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Country | US
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Telephone | 734-833-8082
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Fax | 734-833-8082
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6851120765
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License Number State | MI
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