Individual
KENOSHA WITHERSPOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
9365 E OUTER DR, DETROIT, MI 48213-1507
(313) 695-5416
Mailing address
9365 E OUTER DR, DETROIT, MI 48213-1507
(313) 695-5416
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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