Individual
JILLIAN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30057 8 MILE RD, LIVONIA, MI 48152-1893
(214) 269-3875
(903) 328-6568
Mailing address
30057 8 MILE RD, LIVONIA, MI 48152-1893
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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