Individual provider · NPI-1

Antholyn Floyed-Jackson

Day Training/Habilitation Specialist · Detroit, MI

NPI number1215696927
StatusActive
Last updated in NPPESDec 9, 2021

Details

NPI
1215696927
Entity type
Individual (NPI-1)
Name
Antholyn Floyed-Jackson
Sex
Female
Sole proprietor
No
Enumeration date
Dec 9, 2021
Certification date
Dec 9, 2021
Last updated
Dec 9, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
373H00000X Day Training/Habilitation Specialist––Yes

Practice location

3111 Grand River Ave
Detroit, MI 48208-2962

Phone 313-557-8620

Mailing address

17167 Bonstelle Ave
Southfield, MI 48075-3470

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