Healthcare Provider Details

I. General information

NPI: 1760682900
Provider Name (Legal Business Name): DR. NANCY BLIEDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29260 FRANKLIN RD SUITE 105
SOUTHFIELD MI
48034-1161
US

IV. Provider business mailing address

29260 FRANKLIN RD SUITE 105
SOUTHFIELD MI
48034-1161
US

V. Phone/Fax

Practice location:
  • Phone: 248-352-5999
  • Fax: 248-538-8604
Mailing address:
  • Phone: 248-352-5999
  • Fax: 248-538-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007569
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number6301007569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: