MEDICARE: EMILY ANDERSON 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

General Provider Information

NPI Number	:	1770271439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANDERSON MSW

Provider Business Mailing Address
First Line	:	3510 PHEASANT RUN CIR APT 6
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-2406
Country	:	US
Telephone Number	:	208-921-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 LITTLE LAKE DR STE A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6220
Country	:	US
Telephone Number	:	734-719-0380
Fax Number	:	734-280-2230

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

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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