MEDICARE: DAISY ALDRIDGE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1568561967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY ALDRIDGE MA

Provider Business Mailing Address
First Line	:	19335 MARLOWE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1948
Country	:	US
Telephone Number	:	133-575-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	20400 PLYMOUTH RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-1222
Country	:	US
Telephone Number	:	313-296-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/30/2018

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Directions to “ DAISY ALDRIDGE MA” Practice Location

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