Individual
GWENDOLYN D DEWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, LBSW
Contact information
Practice address
2761 E JEFFERSON AVE, DETROIT, MI 48207-4105
(313) 993-3964
(313) 993-1372
Mailing address
2761 E JEFFERSON AVE, DETROIT, MI 48207-4105
(313) 993-3964
(313) 993-1372
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6802059768
MI
163W00000X
Registered Nurse
Primary
4704157517
MI
Other
Enumeration date
09/11/2008
Last updated
09/11/2008
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