Provider Demographics
NPI:1477021657
Name:POTTER, JANETTE MAE (MS LLP)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:MAE
Last Name:POTTER
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:MAE
Other - Last Name:LABURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LLP
Mailing Address - Street 1:23400 ALLOR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1147
Mailing Address - Country:US
Mailing Address - Phone:586-994-0772
Mailing Address - Fax:
Practice Address - Street 1:1660 FORT ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2003
Practice Address - Country:US
Practice Address - Phone:734-304-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007137103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty