Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801094961 | MI |
NPI | 1003155581 |
---|---|
Provider Name | Steven Stuckey |
First Address | Redford, MI 48240-1544 |
Second Address | Redford, MI 48240-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 04/02/2013 |