Provider Demographics
NPI:1629286471
Name:KAUFMAN, JANIS SUE (MED, ATR)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:SUE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MED, ATR
Other - Prefix:MS
Other - First Name:JANIS
Other - Middle Name:SUE
Other - Last Name:ROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, ATR
Mailing Address - Street 1:520 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2849
Mailing Address - Country:US
Mailing Address - Phone:248-543-8164
Mailing Address - Fax:
Practice Address - Street 1:8600 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2142
Practice Address - Country:US
Practice Address - Phone:313-875-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI05-090221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist