Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | L1294567 | MI |
NPI | 1003140708 |
---|---|
Provider Name | Mrs. Keely F Bartel |
First Address | Northville, MI 48167-1656 |
Second Address | Northville, MI 48167-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2009 |
Last Update Date | 28/09/2009 |