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General NPI Number Information
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NPI Number | 1124647425
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Entity Type | Organization
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Legal Business Name | SHAZIA SIDDIQI PLLC
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 36 E 14 MILE RD
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City | CLAWSON
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State | MI
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Zip | 48017-2133
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Country | US
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Telephone | 248-397-4649
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Fax |
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Provider Business Mailing Address
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Address Line | 951 LONGFELLOW DR
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City | TROY
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State | MI
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Zip | 48085-7900
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Country | US
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Telephone | 248-210-5118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAZIA SIDDIQI
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Credential | LPC
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Telephone | 248-397-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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