Healthcare Provider Details

I. General information

NPI: 1194973271
Provider Name (Legal Business Name): CRYSTAL CEDERNA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VICTORS WAY STE 175
ANN ARBOR MI
48108-5224
US

IV. Provider business mailing address

900 VICTORS WAY STE 175
ANN ARBOR MI
48108-5224
US

V. Phone/Fax

Practice location:
  • Phone: 734-968-2801
  • Fax:
Mailing address:
  • Phone: 734-968-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301014231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: