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General NPI Number Information
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NPI Number | 1700790771
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Entity Type | Individual
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Provider Name | MADELEINE REARDON
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Gender | Female
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 3901 CHRYSLER DR
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City | DETROIT
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State | MI
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Zip | 48201-2167
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Country | US
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Telephone | 586-703-6250
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Fax |
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Provider Business Mailing Address
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Address Line | 7043 CHIRCO DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-3423
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Country | US
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Telephone | 586-703-6250
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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 | 6362010145
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License Number State | MI
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