Provider Demographics
NPI:1164030219
Name:WIERSMA, ANN (LLP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:WIERSMA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27980 GREENING ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3715
Mailing Address - Country:US
Mailing Address - Phone:248-760-8873
Mailing Address - Fax:
Practice Address - Street 1:26711 WOODWARD AVE STE 301
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1369
Practice Address - Country:US
Practice Address - Phone:248-760-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006596103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic