Individual
GWEN WIACEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10038 HAGENSVILLE RD, POSEN, MI 49776-9407
(989) 766-9956
Mailing address
10038 HAGENSVILLE RD, POSEN, MI 49776-9407
(989) 766-9956
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
AF710290749
MI
Other
Enumeration date
12/27/2016
Last updated
12/27/2016
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