MEDICARE: LUCINDA ORWOLL

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	103T00000X	Psychologist	6301009818	MI

General Provider Information

NPI Number	:	1376564591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINDA ORWOLL

Provider Business Mailing Address
First Line	:	1596 KIRTLAND DR
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-5724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6022 W MAPLE RD STE 408
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4408
Country	:	US
Telephone Number	:	734-945-3024
Fax Number	:

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/08/2007

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Directions to “ LUCINDA ORWOLL ” Practice Location

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