Individual
GWEN WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 PORTER ST, DETROIT, MI 48216-1936
(313) 963-6601
Mailing address
1600 PORTER ST, DETROIT, MI 48216-1936
(313) 963-6601
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W426293651569
—
MI
Enumeration date
12/13/2017
Last updated
12/13/2017
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