Healthcare Provider Details

I. General information

NPI: 1184898280
Provider Name (Legal Business Name): MISSI NADEAU PH.D. P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 PECK ST
MUSKEGON MI
49441-2507
US

IV. Provider business mailing address

PO BOX 5092
MUSKEGON MI
49445-5092
US

V. Phone/Fax

Practice location:
  • Phone: 231-722-7751
  • Fax:
Mailing address:
  • Phone: 231-722-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301007867
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301007867
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301007867
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007867
License Number StateMI

VIII. Authorized Official

Name: DR. MISSI NADEAU
Title or Position: SOLE PROPRIETOR
Credential: PH.D.
Phone: 231-722-7751