Healthcare Provider Details

I. General information

NPI: 1437067428
Provider Name (Legal Business Name): REILLY MACKENNA NIESZ MA, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29550 FIVE MILE RD
LIVONIA MI
48154-3710
US

IV. Provider business mailing address

26545 AMERICAN DR
SOUTHFIELD MI
48034-6115
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: