Healthcare Provider Details

I. General information

NPI: 1679104301
Provider Name (Legal Business Name): STACY JEAN-BAPTISTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 KELLY RD
DETROIT MI
48225-1206
US

IV. Provider business mailing address

3141 INTERNATIONAL DR APT 2214
YPSILANTI MI
48197-3165
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-7000
  • Fax:
Mailing address:
  • Phone: 773-986-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: