MEDICARE: MRS. NANCY JEAN WILLIS 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	6801117431	MI
2	104100000X	Social Worker	M-07172	NM
3	104100000X	Social Worker	081889-1	NY

General Provider Information

NPI Number	:	1528374907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY JEAN WILLIS LMSW

Provider Business Mailing Address
First Line	:	5060 JACKSON RD STE D
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1867
Country	:	US
Telephone Number	:	734-627-8001
Fax Number	:	734-433-1989

Provider Business Practice Location Address
First Line	:	5060 JACKSON RD STE D
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1867
Country	:	US
Telephone Number	:	734-627-8001
Fax Number	:	734-433-1989

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	10/29/2025

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