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General NPI Number Information
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NPI Number | 1598214389
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Entity Type | Organization
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Legal Business Name | WAYNE STATE UNIVERSITY SPEECH AND LANGUAGE CENTER
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 60 FARNSWORTH ST
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City | DETROIT
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State | MI
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Zip | 48202-4060
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Country | US
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Telephone | 313-577-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 60 FARNSWORTH ROOM 207
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City | DETROIT
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State | MI
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Zip | 48202
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Country | US
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Telephone | 313-577-3339
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Fax |
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Authorized Official
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Title or Position | CLINICAL INSTRUCTOR
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Name | MRS. MARYELLEN LIENING
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Credential | M.A CCC-SLP
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Telephone | 313-577-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7101001401
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License Number State | MI
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