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General NPI Number Information
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NPI Number | 1396259487
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Entity Type | Individual
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Provider Name | EMILY OUILLETTE
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Gender | Female
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 195 W 9 MILE RD STE 103
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City | FERNDALE
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State | MI
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Zip | 48220-1749
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Country | US
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Telephone | 734-259-4625
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Fax |
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Provider Business Mailing Address
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Address Line | 18590 BRENTWOOD ST
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City | LIVONIA
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State | MI
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Zip | 48152-3508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301012437
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License Number State | MI
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