Individual
MRS. JESSE-LYN SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35425 W MICHIGAN AVE, WAYNE, MI 48184-9800
(734) 722-7498
Mailing address
34934 DONNELLY ST, WESTLAND, MI 48185-3511
(419) 410-8154
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/04/2014
Last updated
06/02/2015
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