Healthcare Provider Details

I. General information

NPI: 1295302537
Provider Name (Legal Business Name): MADELINE CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date: 02/27/2023
Reactivation Date: 03/14/2023

III. Provider practice location address

1360 PORTER ST
DEARBORN MI
48124-2890
US

IV. Provider business mailing address

9409 N HAGGERTY RD
PLYMOUTH MI
48170-4696
US

V. Phone/Fax

Practice location:
  • Phone: 313-689-5188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: