Individual
KENNETH EATMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
5728 WOODLAND VW, CLARKSTON, MI 48346-2637
(312) 933-1459
Mailing address
5728 WOODLAND VW, CLARKSTON, MI 48346-2637
(312) 933-1459
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361004219
MI
103TF0200X
Forensic Psychologist
6361004219
MI
Other
Enumeration date
03/06/2014
Last updated
02/18/2025
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