Provider Demographics
NPI:1225330350
Name:AYLWORTH, PAUL HENRY
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HENRY
Last Name:AYLWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 GOLF CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-9002
Mailing Address - Country:US
Mailing Address - Phone:517-428-1713
Mailing Address - Fax:
Practice Address - Street 1:4208 GOLF CLUB RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-9002
Practice Address - Country:US
Practice Address - Phone:517-428-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA937491041C0700X
MI6801108325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical