Provider Demographics
NPI:1013213735
Name:LINDA AARDEMA PSY S PLLC
Entity Type:Organization
Organization Name:LINDA AARDEMA PSY S PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-414-0754
Mailing Address - Street 1:950 E MAPLE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6408
Mailing Address - Country:US
Mailing Address - Phone:248-540-4242
Mailing Address - Fax:
Practice Address - Street 1:950 E MAPLE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6408
Practice Address - Country:US
Practice Address - Phone:248-540-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M20880Medicare PIN