Kelly Fornwalt

NPI #1174821938 in Plymouth, Michigan

Provider Information

NPI Number: 1174821938
Entity Type: Individual
Name: Kelly Fornwalt
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Enumeration Date: Mar 3, 2011
Last Updated: Mar 3, 2011

Practice Location

Address: 271 S MAIN ST
City: Plymouth
State: Michigan
ZIP Code: 48170-1637
Phone: (734) 455-4095

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X	Primary

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