Healthcare Provider Details

I. General information

NPI: 1730385170
Provider Name (Legal Business Name): MR. DEMPSTER K YALLAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 TELEGRAPH RD
REDFORD MI
48239-1260
US

IV. Provider business mailing address

929 SHERBOURNE ST
INKSTER MI
48141-1381
US

V. Phone/Fax

Practice location:
  • Phone: 313-450-4500
  • Fax:
Mailing address:
  • Phone: 313-561-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6802073612
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802073612
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: