Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801094601 | MI |
NPI | 1003213356 |
---|---|
Provider Name | Stephani Mcisaac |
First Address | Inkster, MI 48141-1089 |
Second Address | Inkster, MI 48141-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 02/12/2014 |