Individual
MS. BARBARA ANNE PETTWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1413 FIELD ST, DETROIT, MI 48214-2321
(313) 347-2070
(313) 579-1819
Mailing address
1413 FIELD ST, DETROIT, MI 48214-2321
(313) 347-2070
(313) 579-1819
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
MI
252Y00000X
Early Intervention Provider Agency
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38-15555827
—
MI
Enumeration date
06/30/2016
Last updated
06/30/2016
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