Individual
DIANE GROSS WILLENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA.CCC-SLP
Contact information
Practice address
25865 W 12 MILE RD, SOUTHFIELD, MI 48034-1817
(313) 623-5898
(248) 208-7494
Mailing address
5640 WESTWOOD CT, BLOOMFIELD HILLS, MI 48301-1237
(248) 865-3452
(248) 208-7494
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
00512863
MI
Other
Enumeration date
10/19/2011
Last updated
10/19/2011
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