Healthcare Provider Details

I. General information

NPI: 1275417909
Provider Name (Legal Business Name): CIARA CANNOY PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD
SALINE MI
48176-9773
US

IV. Provider business mailing address

230 COLUMBUS DR
ANN ARBOR MI
48103-2781
US

V. Phone/Fax

Practice location:
  • Phone: 734-295-4425
  • Fax:
Mailing address:
  • Phone: 989-965-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301019554
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019554
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7111
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP7111
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: