Provider Demographics
NPI:1033290846
Name:WRIGHT, MARTHA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:248-922-9077
Mailing Address - Fax:248-922-9040
Practice Address - Street 1:5639 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3149
Practice Address - Country:US
Practice Address - Phone:248-922-9077
Practice Address - Fax:248-922-9040
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F331960OtherBLUE CROSS BLUE SHIELD
0007543619OtherAETNA
MI680F331960OtherBLUE CROSS BLUE SHIELD
MIN94820002Medicare PIN
0007543619OtherAETNA