MEDICARE: DEWAND GUYTON 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
1	104100000X	Social Worker	6801100049	MI

General Provider Information

NPI Number	:	1538512868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEWAND GUYTON LLMSW

Provider Business Mailing Address
First Line	:	16494 W 11 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4705
Country	:	US
Telephone Number	:	248-957-9163
Fax Number	:	248-957-9165

Provider Business Practice Location Address
First Line	:	26105 ORCHARD LAKE RD STE 309
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4510
Country	:	US
Telephone Number	:	248-957-9163
Fax Number	:	248-957-9165

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

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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