Healthcare Provider Details

I. General information

NPI: 1962798272
Provider Name (Legal Business Name): KRISTIN ANNE FELGENAUER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20303 KELLY RD
DETROIT MI
48225-1206
US

IV. Provider business mailing address

20303 KELLY RD
DETROIT MI
48225-1206
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-7000
  • Fax: 313-245-7009
Mailing address:
  • Phone: 313-245-7000
  • Fax: 313-245-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: