Individual
TRACEY LYNN FALLETICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35425 W MICHIGAN AVE, WAYNE, MI 48184-9800
(734) 722-5986
Mailing address
36118 CANYON DR, WESTLAND, MI 48186-4162
(734) 721-6055
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6802089266
MI
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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