Individual
KELLI HACKEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43825 MICHIGAN AVE, CANTON, MI 48188-2551
(734) 397-3088
Mailing address
26100 W 12 MILE RD APT 233, SOUTHFIELD, MI 48034-1711
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
4704334763
MI
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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