MEDICARE: DR. HEATHER RUTH KADRICH 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
1	103TC0700X	Clinical Psychologist	6301019053	MI

General Provider Information

NPI Number	:	1790114205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER RUTH KADRICH LLP

Provider Business Mailing Address
First Line	:	4401 PARK RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9508
Country	:	US
Telephone Number	:	313-580-6845
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 PARK RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9508
Country	:	US
Telephone Number	:	313-580-6845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	01/25/2022

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