Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003359522 |
---|---|
Provider Name | Jayne Brinkman-Wilkinson |
First Address | South Lyon, MI 48178-1151 |
Second Address | South Lyon, MI 48178-1151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2016 |
Last Update Date | 01/12/2016 |