Individual
SHUBHRA KANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4405 HERITAGE AVE, APT B5, OKEMOS, MI 48864
(414) 255-7795
Mailing address
4405 HERITAGE AVE, APT B5, OKEMOS, MI 48864-3324
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016304
MI
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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