Individual
MAUREEN MICKALONIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5555 CONNER ST STE 1000S, DETROIT, MI 48213-3699
(734) 775-2647
Mailing address
5555 CONNER #1000S, DETROIT, MI 48213
(734) 775-2647
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301008846
MI
Other
Enumeration date
08/04/2009
Last updated
08/04/2009
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