Provider Demographics
NPI:1255595914
Name:NADEAU, TODD JOHN (MA, LLP)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:JOHN
Last Name:NADEAU
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9287 SILVERSIDE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9316
Mailing Address - Country:US
Mailing Address - Phone:586-764-0637
Mailing Address - Fax:810-695-0343
Practice Address - Street 1:9287 SILVERSIDE
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9316
Practice Address - Country:US
Practice Address - Phone:586-764-0637
Practice Address - Fax:810-695-0343
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009306103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103T00000XBehavioral Health & Social Service ProvidersPsychologist