Tiaja N Wynn

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801108257 Issued in MI

Practice address

26300 Outer Dr
Lincoln Park, MI 48146-2019

Phone

(313) 388-4630

NPI assigned

Jan 21, 2021

Sex

Female

Sole proprietor

No

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, last updated by the provider on May 7, 2025.

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1225628571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2466 TWIN LAKES DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26300 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462019",
            "telephone_number": "313-388-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "TIAJA",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801108257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lincoln Park, MI
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.