Most Relevant Information
Provider Data
| NPI Number: | 1003692047 |
| Provider Name: | STEPHANIE WISNIEWSKI TLLP |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | 6362010015 |
Most Important Dates
| Enumeration Date: | 09/06/2023 |
| Last Updated: | 09/19/2024 |
Provider Practice Location
26545 AMERICAN DR
SOUTHFIELD
MI
480346115
Practice Location Phone/Fax
| Phone: | 8003953223 |
| Fax: |
Provider Mailing Location
57236 GOODISON APT 2211
NEW HUDSON
MI
481657043
Provider Mailing Phone/Fax
| Phone: | 9897983617 |
| Fax: |