Provider Demographics
NPI:1295549426
Name:DANZY, KELLY JO (CPRC, CHW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:DANZY
Suffix:
Gender:F
Credentials:CPRC, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24568 RAMSGATE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3223
Mailing Address - Country:US
Mailing Address - Phone:586-843-7712
Mailing Address - Fax:
Practice Address - Street 1:43800 GARFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1136
Practice Address - Country:US
Practice Address - Phone:586-322-7028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker