Individual
CARYETTE FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBSW, QIDP
Contact information
Practice address
2140 E ELLSWORTH RD, ANN ARBOR, MI 48108-2552
(734) 222-3433
(734) 222-3461
Mailing address
555 TOWNER ST, P.O. BOX 915, YPSILANTI, MI 48198-5752
(734) 544-3000
(734) 544-6732
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802081466
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6802081466
STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
06/29/2015
Last updated
06/29/2015
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