Healthcare Provider Details

I. General information

NPI: 1750713210
Provider Name (Legal Business Name): JANET IRENE MCALPINE MALLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21650 BEHRENDT AVE
WARREN MI
48091-2781
US

IV. Provider business mailing address

21650 BEHRENDT AVE
WARREN MI
48091-2781
US

V. Phone/Fax

Practice location:
  • Phone: 586-764-9916
  • Fax:
Mailing address:
  • Phone: 586-764-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6301010211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: