Active NPI
Stephanie Anne Wambold, MSW
- Clinical Social Worker
- Flint, MI
National Provider Identifier
1194253492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801093939
- Practice address
- 4302 Underhill Dr
Flint, MI 48506 - Phone
- (734) 998-2163
- NPI assigned
- May 31, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801093939 | MI | Primary |
Addresses
Primary practice location
4302 Underhill Dr
Flint, MI 48506
Mailing address
3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047
Other names 1
- Stephanie Anne Cerqua
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1194253492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"address_2": "700 KMS PLACE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4302 UNDERHILL DR",
"city": "FLINT",
"state": "MI",
"postal_code": "48506",
"telephone_number": "734-998-2163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAMBOLD",
"first_name": "STEPHANIE",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-31",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801093939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "CERQUA",
"middle_name": "ANNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.