Individual
JILLIAN BOSTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195
(734) 785-7700
Mailing address
24638 COLGATE ST, DEARBORN HEIGHTS, MI 48125-1608
(313) 676-7122
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801102614
MI
Other
Enumeration date
09/09/2017
Last updated
06/01/2018
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