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General NPI Number Information
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NPI Number | 1568683761
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Entity Type | Organization
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Legal Business Name | EASTER SEALS - MICHIGAN
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 22150 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-6007
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Country | US
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Telephone | 248-372-6800
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Fax | 248-357-6090
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Provider Business Mailing Address
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Address Line | 22150 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-6007
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Country | US
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Telephone | 248-372-6800
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Fax | 248-357-6090
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Authorized Official
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Title or Position | SITE MANGAGE
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Name | MRS. KERRI SELLERS
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Credential | MA
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Telephone | 248-372-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801088483
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License Number State | MI
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