Provider Demographics
NPI:1760606313
Name:ALDENBRAND, MARTHA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LYNN
Last Name:ALDENBRAND
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 1:2290 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3233
Mailing Address - Country:US
Mailing Address - Phone:517-349-6396
Mailing Address - Fax:
Practice Address - Street 1:2290 BENNETT RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3233
Practice Address - Country:US
Practice Address - Phone:517-349-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002529103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1007240OtherMCCLAREN HEALTH CARE
MI1007240OtherMCCLAREN HEALTH CARE