Individual
JACQUELYN ELYOUSSEF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3930 ACADEMY ST, DEARBORN HEIGHTS, MI 48125
(313) 804-1888
Mailing address
4501 WOODWARD AVE # 101, DETROIT, MI 48201-1890
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
E421356080673
MI
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/05/2016
Last updated
07/19/2018
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