Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301014076 | MI |
Y | 103T00000X | Psychologist | 6301014076 | MI |
NPI | 1013155514 |
---|---|
Provider Name | Ms. Jennifer Lynn Felicelli |
First Address | Northville, MI 48168-3048 |
Second Address | Northville, MI 48168-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 22/01/2009 |