Individual
JERRY DEPOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
29566 NORTHWESTERN HWY STE 100, SOUTHFIELD, MI 48034-1036
(248) 301-1098
Mailing address
1216 SYCAMORE DR, JENISON, MI 49428-8336
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MI
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
10/23/2019
Last updated
05/01/2026
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