Provider Demographics
NPI:1982198065
Name:HADEN, EMMA-JO
Entity Type:Individual
Prefix:
First Name:EMMA-JO
Middle Name:
Last Name:HADEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA-JO
Other - Middle Name:
Other - Last Name:BEHRENDORFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6106
Mailing Address - Country:US
Mailing Address - Phone:248-969-9375
Mailing Address - Fax:248-969-9478
Practice Address - Street 1:1350 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6106
Practice Address - Country:US
Practice Address - Phone:248-969-9375
Practice Address - Fax:248-969-9478
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant