Active NPI
Elizabeth Wynne
- Social Worker
- Clinton TWP, MI
National Provider Identifier
1841058344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851109682
- Practice address
- 38800 Garfield Rd Ste 100
Clinton TWP, MI 48038-6619 - Phone
- (586) 231-0306
- NPI assigned
- Mar 8, 2024
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6851109682 | MI | Primary |
Addresses
Primary practice location
38800 Garfield Rd Ste 100
Clinton TWP, MI 48038-6619
Mailing address
28181 Palm Beach Dr
Warren, MI 48093-4910
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851109682 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Professional Services | Current | Accepting new patients |
Locations
38800 Garfield Rd
Ste 100
Clinton Twp, MI 48038
Phone (586) 231-0306
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Clinton Township, MI
- NPI 1518329671
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709856000000",
"number": "1841058344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28181 PALM BEACH DR",
"city": "WARREN",
"state": "MI",
"postal_code": "480934910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38800 GARFIELD RD STE 100",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480386619",
"telephone_number": "586-231-0306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNNE",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-08",
"last_updated": "2024-03-08",
"certification_date": "2024-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851109682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.