Individual
STEPHANIE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHN, LMT
Contact information
Practice address
207 E BALTIMORE ST, DETROIT, MI 48202-3278
(313) 600-7505
Mailing address
207 E BALTIMORE ST APT 6, DETROIT, MI 48202-3278
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
89433--CERTIFICATION
MI
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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