MEDICARE: GABRIELA ZAMORA-AHLSTROM MSW

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	104100000X	Social Worker	6801073863	MI

General Provider Information

NPI Number	:	1518969443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA ZAMORA-AHLSTROM MSW

Provider Business Mailing Address
First Line	:	53375 WHITBY WAY
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-2751
Country	:	US
Telephone Number	:	586-291-7557
Fax Number	:	248-266-6895

Provider Business Practice Location Address
First Line	:	53375 WHITBY WAY
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-2751
Country	:	US
Telephone Number	:	586-291-7557
Fax Number	:	248-266-6895

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/15/2018

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