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General NPI Number Information
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NPI Number | 1699409417
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Entity Type | Individual
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Provider Name | DEANN WILEY
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Gender | Female
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 07/16/2022
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Provider Practice Location Address
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Address Line | 6548 TOWN CENTER DR STE D
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City | CLARKSTON
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State | MI
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Zip | 48346-4823
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Country | US
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Telephone | 644-231-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 CANTON ST
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City | DETROIT
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State | MI
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Zip | 48207-3603
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Country | US
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Telephone | 313-595-6261
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009532
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License Number State | MI
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