Basic Information
| Provider Information | |||||||||
| NPI: | 1902964430 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TJADEN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29201 TELEGRAPH ROAD | ||||||||
| Address2: | 550 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | 2482130521 | ||||||||
| Practice Location | |||||||||
| Address1: | 29201 TELEGRAPH ROAD | ||||||||
| Address2: | 550 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | 2482130521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| 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 | 1041C0700X | 6801011497 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7530443 | 01 | AETHE | OTHER | 2053814 | 01 | CIGNA | OTHER |