Healthcare Provider Details

I. General information

NPI: 1518274331
Provider Name (Legal Business Name): EMILY JANE ESCOTT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23650 WOODWARD AVE
PLEASANT RIDGE MI
48069-1128
US

IV. Provider business mailing address

2331 HAMATA ST
FERNDALE MI
48220-1549
US

V. Phone/Fax

Practice location:
  • Phone: 248-346-1200
  • Fax:
Mailing address:
  • Phone: 248-909-2023
  • Fax: 313-656-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016394
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301016394
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6301016394
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301016394
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: