MEDICARE: MRS. WENDY NICOLE MYERS-CROMWELL LMSW

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	6801081669	MI
2	1041S0200X	School Social Worker	6801081669	MI

General Provider Information

NPI Number	:	1356491617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY NICOLE MYERS-CROMWELL LMSW

Provider Business Mailing Address
First Line	:	1063 TREVOR PL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3809
Country	:	US
Telephone Number	:	313-971-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	19855 OUTER DR STE 104W
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2027
Country	:	US
Telephone Number	:	313-971-7822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	12/30/2011

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