Healthcare Provider Details

I. General information

NPI: 1831642560
Provider Name (Legal Business Name): STEPHANIE MEWES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 W GRAND BLVD
DETROIT MI
48208-1105
US

IV. Provider business mailing address

2051 W GRAND BLVD
DETROIT MI
48208-1105
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-4466
  • Fax:
Mailing address:
  • Phone: 313-961-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801099368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: