Provider Demographics
NPI:1720286693
Name:VILLET, WANDA F (MSW)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:F
Last Name:VILLET
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:MI
Mailing Address - Zip Code:49310-9428
Mailing Address - Country:US
Mailing Address - Phone:989-561-5019
Mailing Address - Fax:
Practice Address - Street 1:2511 MONROE RD
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:MI
Practice Address - Zip Code:49310-9428
Practice Address - Country:US
Practice Address - Phone:989-561-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool