MEDICARE: MRS. SALLY LOU DUNNING LMSW, ACSW

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	6801061435	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8008949410	OTHER	MI	BLUE CROSS PROVIDER NUMBE

General Provider Information

NPI Number	:	1881748150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY LOU DUNNING LMSW, ACSW

Provider Business Mailing Address
First Line	:	2851 RENFREW ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-1451
Country	:	US
Telephone Number	:	734-663-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 E STADIUM BLVD
Second Line	:	105 S
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4833
Country	:	US
Telephone Number	:	734-996-9992
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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