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General NPI Number Information
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NPI Number | 1891424701
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Entity Type | Individual
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Provider Name | JASMONIQUE COLLETTE NORMAN-PRUITT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 23999 W 10 MILE RD # 220
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3158
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Country | US
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Telephone | 248-327-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 19383 HAWTHORNE ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-1310
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Country | US
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Telephone | 313-482-5079
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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