Provider Demographics
NPI:1831929025
Name:CEDERWALL, TALIESYN (LLMSW)
Entity type:Individual
Prefix:
First Name:TALIESYN
Middle Name:
Last Name:CEDERWALL
Suffix:
Gender:X
Credentials:LLMSW
Other - Prefix:
Other - First Name:MIKI
Other - Middle Name:
Other - Last Name:CEDERWALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:1423 NATALIE LN APT 103
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2916
Mailing Address - Country:US
Mailing Address - Phone:630-853-1095
Mailing Address - Fax:
Practice Address - Street 1:42217 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4364
Practice Address - Country:US
Practice Address - Phone:734-355-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117264104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker