Provider Demographics
NPI:1760682900
Name:BLIEDEN, NANCY
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:BLIEDEN
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 1:29260 FRANKLIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1161
Mailing Address - Country:US
Mailing Address - Phone:248-352-5999
Mailing Address - Fax:248-538-8604
Practice Address - Street 1:29260 FRANKLIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1161
Practice Address - Country:US
Practice Address - Phone:248-352-5999
Practice Address - Fax:248-538-8604
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007569103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical