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General NPI Number Information
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NPI Number | 1578148532
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Entity Type | Individual
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Provider Name | MADISYN BOBBY
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Gender | Female
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 17282 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3151
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Country | US
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Telephone | 947-228-0344
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Fax |
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Provider Business Mailing Address
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Address Line | 38575 ASH RD
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City | NEW BOSTON
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State | MI
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Zip | 48164-9342
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Country | US
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Telephone | 734-756-4571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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