Provider Demographics
NPI:1669290284
Name:BACKUS, NEAL PATRICK
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:PATRICK
Last Name:BACKUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 WATERLOO ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1201
Mailing Address - Country:US
Mailing Address - Phone:313-473-4730
Mailing Address - Fax:
Practice Address - Street 1:17150 WATERLOO ST
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1201
Practice Address - Country:US
Practice Address - Phone:313-473-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist