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General NPI Number Information
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NPI Number | 1710248620
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Entity Type | Individual
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Provider Name | MS. RANDEE MARLA BASSIN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 9357 GENERAL DR STE 101
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City | PLYMOUTH
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State | MI
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Zip | 48170-4666
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Country | US
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Telephone | 734-454-0866
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Fax |
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Provider Business Mailing Address
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Address Line | 3324 ALPINE DR
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City | ANN ARBOR
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State | MI
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Zip | 48108-1704
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Country | US
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Telephone | 734-474-6804
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 235Z00000X
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License Number State | MI
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