Provider Demographics
NPI:1578148532
Name:BOBBY, MADISYN
Entity Type:Individual
Prefix:
First Name:MADISYN
Middle Name:
Last Name:BOBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38575 ASH RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-9342
Mailing Address - Country:US
Mailing Address - Phone:734-756-4571
Mailing Address - Fax:
Practice Address - Street 1:17282 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3151
Practice Address - Country:US
Practice Address - Phone:947-228-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist