MEDICARE: WAVES OF CHANGE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801094168	MI

General Provider Information

NPI Number	:	1194177675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVES OF CHANGE, LLC

Provider Business Mailing Address
First Line	:	7625 KING RD
Second Line	:
City	:	SPRING ARBOR
State	:	MI
Zip	:	49283-9777
Country	:	US
Telephone Number	:	517-581-4886
Fax Number	:	517-905-6046

Provider Business Practice Location Address
First Line	:	2017 4TH ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4572
Country	:	US
Telephone Number	:	517-581-4886
Fax Number	:	517-905-6046

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	AMBER JOY NORWOOD
Credential	:	LMSW
Telephone Number	:	517-581-4886

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	08/24/2020

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Directions to “WAVES OF CHANGE, LLC ” Practice Location

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