Individual
SHANNON WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 CATALPA DR, ROYAL OAK, MI 48067-1125
(248) 971-0383
Mailing address
37690 CHARTER OAKS BLVD, CLINTON TOWNSHIP, MI 48036-2424
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/27/2012
Last updated
04/27/2012
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