Individual provider · NPI-1
Jacquelyn Elyoussef
Technician, Other · Dearborn Heights, MI
NPI number1558811331
StatusActive
Last updated in NPPESJul 19, 2018
Details
- NPI
- 1558811331
- Entity type
- Individual (NPI-1)
- Name
- Jacquelyn Elyoussef
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 5, 2016
- Last updated
- Jul 19, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 247200000X | Technician, Other | – | – | Yes |
| 106S00000X | Behavior Technician | e421356080673 | MI |
Practice location
3930 Academy StDearborn Heights, MI 48125
Phone 313-804-1888
Mailing address
4501 Woodward Ave # 101Detroit, MI 48201-1890
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