Basic Information
| Provider Information | |||||||||
| NPI: | 1750572418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHISHOLM | ||||||||
| FirstName: | APRIL | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4810 SANDSTONE PASS | ||||||||
| Address2: | APT 1B | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481975040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863814855 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 FORD PL | ||||||||
| Address2: | 1E- NEUROPSYCHOLOGY | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138762526 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 08/07/2007 | ||||||||
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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 | 390200000X | 6301013612 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.