Individual
KATELYN MARIE-FERNANDEZ GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TLLP
Contact information
Practice address
1777 AXTELL DR STE 100, TROY, MI 48084-4400
(248) 613-5377
Mailing address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7704
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
14478193
MI
Other
Enumeration date
05/30/2019
Last updated
11/24/2020
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