Basic Information
Provider Information
NPI: 1427586965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILLIER
FirstName: MARY
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: MSW LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3521 MEADOW GROVE TRL
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481089313
CountryCode: US
TelephoneNumber: 7346606175
FaxNumber:  
Practice Location
Address1: 5958 N CANTON CENTER RD
Address2:  
City: CANTON
State: MI
PostalCode: 481872765
CountryCode: US
TelephoneNumber: 7347371200
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/29/2017
LastUpdateDate: 05/29/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X6801020564MIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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