MEDICARE: JILL HANNA WASSERMAN LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	6401222712	MI

General Provider Information

NPI Number	:	1902156888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL HANNA WASSERMAN LPC

Provider Business Mailing Address
First Line	:	2251 N. SQUIRREL
Second Line	:	STE 315
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-6033
Country	:	US
Telephone Number	:	586-566-3020
Fax Number	:	586-566-3055

Provider Business Practice Location Address
First Line	:	2251 N SQUIRREL RD STE 315
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-4608
Country	:	US
Telephone Number	:	517-492-0784
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	11/13/2024

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