Provider Demographics
NPI:1518274331
Name:ESCOTT, EMILY JANE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JANE
Last Name:ESCOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 HAMATA ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1549
Mailing Address - Country:US
Mailing Address - Phone:248-909-2023
Mailing Address - Fax:313-656-4053
Practice Address - Street 1:23650 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1128
Practice Address - Country:US
Practice Address - Phone:248-346-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016394103TC0700X, 103TC2200X, 103TH0100X, 103TH0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program