Individual
AJAY GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
25865 W 12 MILE RD, SOUTHFIELD, MI 48034-1817
(248) 208-7492
Mailing address
25865 W 12 MILE RD, SOUTHFIELD, MI 48034-1817
(248) 208-7492
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12080163
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12080163
ASHA#
MI
Enumeration date
09/15/2008
Last updated
09/15/2008
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