| Henry Ford Health System-school Based Health Initiative | |
|
13322 Conant Ave Hfhs Cleveland Health Center Detroit MI 48212 | |
| (313) 366-9050 | |
| (313) 366-3809 |
| Full Name | Henry Ford Health System-school Based Health Initiative |
|---|---|
| Speciality | Pediatrics |
| Location | 13322 Conant Ave, Detroit, Michigan |
| Authorized Official Name and Position | Kelly Ratowski (DIRECTOR OF PROVIDER AFFAIRS) |
| Authorized Official Contact | 2487032003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Henry Ford Health System-school Based Health Initiative One Ford Place Ste 4b Hfhs Sbchp Detroit MI 48202 Ph: (313) 874-5426 | Henry Ford Health System-school Based Health Initiative 13322 Conant Ave Hfhs Cleveland Health Center Detroit MI 48212 Ph: (313) 366-9050 |
| NPI Number | 1104010578 |
|---|---|
| Provider Enumeration Date | 08/29/2007 |
| Last Update Date | 03/06/2024 |
| Certification Date | 03/06/2024 |
| Medicare PECOS PAC ID | 3072875517 |
|---|---|
| Medicare Enrollment ID | O20180322000407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104010578 | NPI | - | NPPES |
| Provider Name | Consuelo N Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265783674 PECOS PAC ID: 8224281985 Enrollment ID: I20130104000318 |
| Provider Name | Maureen Connolly |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629331939 PECOS PAC ID: 5698089381 Enrollment ID: I20150810001099 |
| Provider Name | Rachel S Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336583418 PECOS PAC ID: 4880902113 Enrollment ID: I20161227001552 |
| Provider Name | Natalie M Kennaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215437900 PECOS PAC ID: 5193087625 Enrollment ID: I20180322000226 |
| Provider Name | Claudia Jean Pierre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700209913 PECOS PAC ID: 1254674336 Enrollment ID: I20190511000160 |
| Provider Name | Alexandra R Hagerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629569595 PECOS PAC ID: 5890025175 Enrollment ID: I20190930002290 |
| Provider Name | Jessica Lynn Boardman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356798821 PECOS PAC ID: 0749512408 Enrollment ID: I20191029003428 |
| Provider Name | Jasmine Nicole Mays |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114579323 PECOS PAC ID: 6103250642 Enrollment ID: I20191217000069 |
| Provider Name | Mikki Lachelle Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740631589 PECOS PAC ID: 1658706379 Enrollment ID: I20200127000903 |
| Provider Name | Lashawnda Gayden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417388174 PECOS PAC ID: 6800224486 Enrollment ID: I20200313000209 |
| Provider Name | Alana Christine Lagrande |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659964252 PECOS PAC ID: 6608282595 Enrollment ID: I20210301000653 |
| Provider Name | Riley Banks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255878336 PECOS PAC ID: 0749699569 Enrollment ID: I20210507001165 |
| Provider Name | Keara Javon Marks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720757628 PECOS PAC ID: 8628475571 Enrollment ID: I20210921000859 |
| Provider Name | Olivia Jenai Burlison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235619222 PECOS PAC ID: 4688050131 Enrollment ID: I20221006001028 |
| Provider Name | Kristin Gregory-webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871030056 PECOS PAC ID: 0244616589 Enrollment ID: I20221010002876 |
| Provider Name | Alyssia Chantel Hence |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417420514 PECOS PAC ID: 7416310297 Enrollment ID: I20230825003174 |
| Provider Name | Ashley Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922597319 PECOS PAC ID: 1456704592 Enrollment ID: I20240125001275 |
| Provider Name | Mal R Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235654880 PECOS PAC ID: 7315211703 Enrollment ID: I20240201000351 |
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