Provider Demographics
NPI:1598100257
Name:BOODY, VANESSA (LMSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BOODY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:3820 PACKARD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5017
Mailing Address - Country:US
Mailing Address - Phone:734-780-7338
Mailing Address - Fax:
Practice Address - Street 1:3820 PACKARD ST STE 250
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5017
Practice Address - Country:US
Practice Address - Phone:734-780-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8939791-35021041C0700X
MI68011061671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical