Individual
MR. CLARENCE LESLIE WARDELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
8623 N WAYNE RD, SUITE 310, WESTLAND, MI 48185-1137
(734) 425-0636
(734) 425-4771
Mailing address
18959 ELDORADO PL, LATHRUP VILLAGE, MI 48076-4408
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1803540
MI
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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