Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301006107 | MI |
Y | 103T00000X | Psychologist | 6301006107 | MI |
NPI | 1013954502 |
---|---|
Provider Name | Marquita Bedway |
First Address | Detroit, MI 48201-2061 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |