Individual
RAINA PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TLLP
Contact information
Practice address
6425 SCHAEFER RD, DEARBORN, MI 48126-1974
(313) 846-8606
Mailing address
22162 MALDEN ST, FARMINGTN HLS, MI 48336-3858
(313) 377-2570
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301018212
MI
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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