Basic Information
Provider Information
NPI: 1184658379
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPIER
FirstName: LINDA
MiddleName: L
NamePrefix: MS.
NameSuffix:  
Credential: MA, LLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CELLAR
OtherFirstName: LINDA
OtherMiddleName: L
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 28000 DEQUINDRE RD
Address2:  
City: WARREN
State: MI
PostalCode: 480922468
CountryCode: US
TelephoneNumber: 5867530405
FaxNumber: 5867530404
Practice Location
Address1: 5111 AUTO CLUB DR
Address2: #120
City: DEARBORN
State: MI
PostalCode: 481262749
CountryCode: US
TelephoneNumber: 3135830735
FaxNumber: 3135830751
Other Information
ProviderEnumerationDate: 07/11/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X6301007997MIY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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