Individual
MS. BRANDY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
37301 RADDE ST, CLINTON TOWNSHIP, MI 48036-2932
(313) 400-4028
Mailing address
37301 RADDE ST, CLINTON TOWNSHIP, MI 48036-2932
(313) 400-4028
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8640
—
MI
Enumeration date
08/20/2020
Last updated
08/20/2020
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