MEDICARE: HANNAH WINGO LMSW, 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	1041C0700X	Clinical Social Worker	6801093220	MI

General Provider Information

NPI Number	:	1760842991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH WINGO LMSW, MSW

Provider Business Mailing Address
First Line	:	8623 N WAYNE RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1137
Country	:	US
Telephone Number	:	734-367-0469
Fax Number	:

Provider Business Practice Location Address
First Line	:	18400 SCHAEFER HWY
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1754
Country	:	US
Telephone Number	:	248-631-8517
Fax Number	:

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

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	11/18/2022

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