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Individual

JACQUELYN KENNEDY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
16811 LAUDER ST, DETROIT, MI 48235-4037
(313) 273-2093
Mailing address
16811 LAUDER ST, DETROIT, MI 48235-4037
(313) 273-2093

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
171M00000X
Case Manager/Care Coordinator
172A00000X
Driver

Other

Enumeration date
05/14/2016
Last updated
05/14/2016
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