Provider Demographics
NPI:1093861627
Name:YEZMAN, RODY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODY
Middle Name:
Last Name:YEZMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RODY
Other - Middle Name:
Other - Last Name:YEZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:29688 TELEGRAPH RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1362
Mailing Address - Country:US
Mailing Address - Phone:248-354-4422
Mailing Address - Fax:248-354-9956
Practice Address - Street 1:29688 TELEGRAPH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1362
Practice Address - Country:US
Practice Address - Phone:248-354-4422
Practice Address - Fax:248-354-9956
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001920103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist