Individual
JAMIE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
882 OAKMAN BLVD, DETROIT, MI 48238-3710
(248) 974-2363
Mailing address
882 OAKMAN, DETROIT, MI 48238
(248) 974-2363
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6803085419
MI
Other
Enumeration date
12/06/2013
Last updated
09/09/2024
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