Individual
JACQUELYN CLEMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLBSW
Contact information
Practice address
4300 6TH ST, ECORSE, MI 48229-1110
(313) 724-6192
Mailing address
9348 TOBINE ST, ROMULUS, MI 48174-3365
(313) 285-0156
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MI
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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