1871613968 NPI number — LIDDERDALE CONSULTING PLC

Table of content: (NPI 1871613968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871613968 NPI number — LIDDERDALE CONSULTING PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIDDERDALE CONSULTING PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MELISSA A. LIDDERDALE, PLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871613968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 COURTLAND ST UNIT 794
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49341-5027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-426-9193
Provider Business Mailing Address Fax Number:
616-426-9455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
668 3 MILE RD NW STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49544-8219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-426-9193
Provider Business Practice Location Address Fax Number:
616-426-9455
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIDDERDALE
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PSYCHOLOGIST/OWNER
Authorized Official Telephone Number:
616-426-9193

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301012277 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 6301014348 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X , with the licence number: 6301012277 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 6301014348 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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