Individual
TARA SANDRA MARIE TOWNSEND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10103 DIXIE HWY APT 3, CLARKSTON, MI 48348-2457
(248) 785-8773
Mailing address
10103 DIXIE HWY APT 3, CLARKSTON, MI 48348-2457
(248) 785-8773
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105340379
—
MI
Enumeration date
02/19/2016
Last updated
02/19/2016
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