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General NPI Number Information
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NPI Number | 1922194612
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Entity Type | Individual
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Provider Name | KATHLEEN JUNE KONWIAK LLP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 22151 MOROSS RD PB1 SUITE 334
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City | DETROIT
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State | MI
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Zip | 48236-2167
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Country | US
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Telephone | 313-343-8784
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Fax | 313-343-7449
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Provider Business Mailing Address
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Address Line | 28000 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092
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Country | US
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Telephone | 586-753-0405
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Fax | 586-753-0404
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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 | 6301004046
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License Number State | MI
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