Healthcare Provider Details

I. General information

NPI: 1699366724
Provider Name (Legal Business Name): FATEN A JAAFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 EUREKA RD STE 200
TAYLOR MI
48180-6394
US

IV. Provider business mailing address

4805 ARGYLE ST
DEARBORN MI
48126-3141
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone: 313-443-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: