Provider Information for 1902249519
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Mr. JEFFREY J HADDOCK LMSW
Sex: Male
NPI: 1902249519
Last Updated: 2021-01-25
Certification Date: 2021-01-25
Certification Date: 2021-01-25
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902249519 | ||||||||||||
| Enumeration Date | 2013-04-12 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6549 TOWN CENTER DR CLARKSTON, MI 48346-4824 United States Phone: 734-422-9340 | Fax: | ||||||||||||
| Primary Practice Address | 31500 SCHOOLCRAFT RD LIVONIA, MI 48150-1805 United States Phone: 734-422-9340 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|