Healthcare Provider Details

I. General information

NPI: 1528088739
Provider Name (Legal Business Name): KAREN JEAN MAIDMENT MSSA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 MARION
REDFORD MI
48239-2017
US

IV. Provider business mailing address

11340 MARION
REDFORD MI
48239-2017
US

V. Phone/Fax

Practice location:
  • Phone: 248-777-0008
  • Fax:
Mailing address:
  • Phone: 248-777-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801083836
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: