Provider Demographics
NPI:1538707831
Name:WALLS, ANNIE SUE
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:SUE
Last Name:WALLS
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 1:1648 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3669
Mailing Address - Country:US
Mailing Address - Phone:734-355-8501
Mailing Address - Fax:734-482-4914
Practice Address - Street 1:1648 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3669
Practice Address - Country:US
Practice Address - Phone:734-355-8501
Practice Address - Fax:734-482-4914
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker