Healthcare Provider Details

I. General information

NPI: 1912697749
Provider Name (Legal Business Name): JACQUELINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W 13 MILE RD STE N300
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

26901 BEAUMONT BLVD # 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3302
  • Fax: 248-551-7373
Mailing address:
  • Phone: 947-522-1952
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: