Individual
KIM DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
46315 WEAR RD, BELLEVILLE, MI 48111-9324
(313) 407-0294
Mailing address
46315 WEAR RD, BELLEVILLE, MI 48111-9324
(313) 407-0294
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/08/2014
Last updated
07/10/2016
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