Provider Demographics
NPI:1841223724
Name:TANSIL, LINDA DIAN (LMSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIAN
Last Name:TANSIL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:DIAN
Other - Last Name:HARRIS/OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:2121 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4543
Practice Address - Country:US
Practice Address - Phone:734-665-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010630111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426268Medicare ID - Type Unspecified