MEDICARE: VALERIE JANE BURNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1912153198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE JANE BURNETT

Provider Business Mailing Address
First Line	:	20105 KELLY RD
Second Line	:	APT. 3
City	:	DETROIT
State	:	MI
Zip	:	48225-1290
Country	:	US
Telephone Number	:	313-289-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4216 MCDOUGALL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-1520
Country	:	US
Telephone Number	:	313-923-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	08/07/2008

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Directions to “ VALERIE JANE BURNETT ” Practice Location

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