Basic Information
| Provider Information | |||||||||
| NPI: | 1699797613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTOLL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4039 HEATHERWOOD CT | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865820524 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24715 LITTLE MACK | ||||||||
| Address2: | #200 | ||||||||
| City: | SAINT CLAIRE SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867779000 | ||||||||
| FaxNumber: | 5867770823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301009123 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.