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NPI Code Detail

MEDICARE: DAWN ROBERTS MS, LLP

MEDICARE: DAWN ROBERTS MS, LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6301011976MI

General Provider Information

NPI Number : 1194278176
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN ROBERTS MS, LLP
Provider Business Mailing Address
First Line : 26005 WHISPERING WILLOWS DR
Second Line :
City : NEW BOSTON
State : MI
Zip : 48164-9194
Country : US
Telephone Number : 313-995-5557
Fax Number :
Provider Business Practice Location Address
First Line : 4111 ANDOVER RD
Second Line :
City : BLOOMFIELD TOWNSHIP
State : MI
Zip : 48302-1909
Country : US
Telephone Number : 248-290-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2016
Last Update Date : 07/26/2016

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