Provider Demographics
NPI:1427108828
Name:STEPHENS, ELAINE MARZETTE (CRT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARZETTE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 ASHTON RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1376
Mailing Address - Country:US
Mailing Address - Phone:313-493-0979
Mailing Address - Fax:
Practice Address - Street 1:27150 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-3590
Practice Address - Country:US
Practice Address - Phone:248-249-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4401003230227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified