Healthcare Provider Details

I. General information

NPI: 1477957124
Provider Name (Legal Business Name): ROBERT ALDSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36050 GODDARD RD
ROMULUS MI
48174-3850
US

IV. Provider business mailing address

6389 4TH ST
ROMULUS MI
48174-1803
US

V. Phone/Fax

Practice location:
  • Phone: 734-995-1555
  • Fax:
Mailing address:
  • Phone: 734-776-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: