MEDICARE: RESHA ROCHELLE-LEE WILLIS

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	6801116468	MI

General Provider Information

NPI Number	:	1598609679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHA ROCHELLE-LEE WILLIS

Provider Business Mailing Address
First Line	:	6170 COUNTY FARM RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-9075
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6170 COUNTY FARM RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-9075
Country	:	US
Telephone Number	:	517-745-5663
Fax Number	:

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

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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