Provider Demographics
NPI:1801771530
Name:DEAN, KHALILAH JOISKINNER
Entity type:Individual
Prefix:
First Name:KHALILAH
Middle Name:JOISKINNER
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 SUMPTER RD STE 126
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4905
Mailing Address - Country:US
Mailing Address - Phone:734-262-6377
Mailing Address - Fax:734-262-6377
Practice Address - Street 1:2146 MOELLER AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-9237
Practice Address - Country:US
Practice Address - Phone:734-262-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker