Stephanie Wisniewski, TLLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6362010015 Issued in MI

Practice address

26545 American Dr
Southfield, MI 48034-6115

Phone

(800) 395-3223

NPI assigned

Sep 6, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1003692047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57236 GOODISON APT 2211",
            "city": "NEW HUDSON",
            "state": "MI",
            "postal_code": "481657043",
            "telephone_number": "989-798-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26545 AMERICAN DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480346115",
            "telephone_number": "800-395-3223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43825 Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481882551",
            "country_code": "US",
            "telephone_number": "734-397-3088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "STEPHANIE",
        "credential": "TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-06",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6362010015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tova E Winters, NP
• Ruthanne K Wirth, CRNA
• Wisdom Home Health Care Inc
• John Anthony Wise, FNP-C
• Susan Lynn Wise, LMSW
• Sydney Wisniewski
• Kelsey Wisotsky
• Omeria Witcher, LLMSW
• Caitlyn Marie Witek, LMSW
• With Ease Transportation

• Clinical Psychologist in Southfield, MI
• Providers in Southfield, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.