Provider Demographics
NPI:1336515170
Name:VANDERWILL, LORI
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:VANDERWILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36888 THINBARK ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1178
Mailing Address - Country:US
Mailing Address - Phone:734-812-9141
Mailing Address - Fax:
Practice Address - Street 1:17321 TELEGRAPH
Practice Address - Street 2:DEVELOPMENT CENTERS
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219
Practice Address - Country:US
Practice Address - Phone:313-255-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical