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General NPI Number Information
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NPI Number | 1790007136
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Entity Type | Organization
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Legal Business Name | JOANNA BIELENIN PC
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 300 N HURON ST
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City | YPSILANTI
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State | MI
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Zip | 48197-2842
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Country | US
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Telephone | 734-476-7282
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Fax |
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Provider Business Mailing Address
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Address Line | 300 N HURON ST
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City | YPSILANTI
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State | MI
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Zip | 48197-2842
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Country | US
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Telephone | 734-476-7282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOANNA BIELENIN
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Credential | PHD
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Telephone | 734-476-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301005020
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License Number State | MI
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