Provider Demographics
NPI:1124550884
Name:IRWIN, KELLY JENNIFER
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JENNIFER
Last Name:IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 185
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2452
Mailing Address - Country:US
Mailing Address - Phone:248-712-4662
Mailing Address - Fax:
Practice Address - Street 1:32100 TELEGRAPH RD
Practice Address - Street 2:SUITE 185
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2452
Practice Address - Country:US
Practice Address - Phone:248-712-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other