Provider Demographics
NPI:1043451388
Name:NELSON, LINDA L (LBSW/ QMRP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:LBSW/ QMRP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LBSW/QMRP
Mailing Address - Street 1:883 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8644
Mailing Address - Country:US
Mailing Address - Phone:248-627-4535
Mailing Address - Fax:
Practice Address - Street 1:1270 DORIS RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2617
Practice Address - Country:US
Practice Address - Phone:248-276-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802021491104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker