Provider Demographics
NPI:1225252331
Name:WILES, JANET MARIE (LMSW, ACSW,)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:WILES
Suffix:
Gender:F
Credentials:LMSW, ACSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 RIVERSHYRE PKWY
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8623
Mailing Address - Country:US
Mailing Address - Phone:810-658-2222
Mailing Address - Fax:
Practice Address - Street 1:4011 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5558
Practice Address - Country:US
Practice Address - Phone:810-235-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010167771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2811OtherMEDICARE PTAN