Provider Demographics
NPI:1508326893
Name:KERWIN, DANIELLE IRENE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:IRENE
Last Name:KERWIN
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 1:3190 W CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2054
Mailing Address - Country:US
Mailing Address - Phone:248-872-8534
Mailing Address - Fax:
Practice Address - Street 1:1349 S HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7021
Practice Address - Country:US
Practice Address - Phone:734-929-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician