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NPI Code Detail

MEDICARE: MISS JILL ETTEMA LLMSW

MEDICARE: MISS JILL ETTEMA LLMSW
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
1104100000XSocial Worker6801095729MI

General Provider Information

NPI Number : 1477983690
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JILL ETTEMA LLMSW
Provider Business Mailing Address
First Line : 2144 PRAIRIE ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-1440
Country : US
Telephone Number : 231-218-8512
Fax Number :
Provider Business Practice Location Address
First Line : 279 SUMMIT DR
Second Line :
City : WATERFORD
State : MI
Zip : 48328-3364
Country : US
Telephone Number : 248-409-4238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2013
Last Update Date : 02/12/2026

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Directions to “ MISS JILL ETTEMA LLMSW” Practice Location

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