Individual
JAY SEAN FALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLMSW
Contact information
Practice address
11111 HALL RD STE 303, UTICA, MI 48317-5726
(586) 997-3153
Mailing address
30739 NEWPORT DR, WARREN, MI 48088-3163
(586) 747-1150
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801095931
MI
Other
Enumeration date
08/15/2013
Last updated
08/15/2013
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