| NPI | 1174136550 |
|---|---|
| Doing Business As | KATELYN M MADDOCK |
| Entity Type | Organization |
| Authorized Contact | CATHY GALLEGOS Credentialing Manager 517-483-2461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2022-02-17 |