Individual
MS. JOANNA ROSE FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
2421 MONROE ST STE 202, DEARBORN, MI 48124-3043
(313) 562-4485
Mailing address
328 SCOTT ST, MONROE, MI 48161-2133
(248) 321-0075
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000465
MI
Other
Enumeration date
06/04/2007
Last updated
05/27/2011
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