Provider Demographics
NPI:1164398509
Name:NAILER, DORTHYJEAN MARY
Entity type:Individual
Prefix:
First Name:DORTHYJEAN
Middle Name:MARY
Last Name:NAILER
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 1:4074 BLAINE ST APT 2W
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-2402
Mailing Address - Country:US
Mailing Address - Phone:334-212-2336
Mailing Address - Fax:
Practice Address - Street 1:4074 BLAINE ST APT 2W
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2402
Practice Address - Country:US
Practice Address - Phone:334-212-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker