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Individual

JACALYN R BEAVERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
29877 TELEGRAPH RD, STE 401, SOUTHFIELD, MI 48034-7661
(248) 358-5334
(248) 356-7596
Mailing address
29877 TELEGRAPH RD, STE 401, SOUTHFIELD, MI 48034-7661
(248) 358-5334
(248) 356-7596

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802083584
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6802083584
STATE LICENSE
MI
Enumeration date
08/31/2006
Last updated
02/05/2008
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