Provider Demographics
NPI:1053776310
Name:TALO, MAIGHDLIN
Entity type:Individual
Prefix:
First Name:MAIGHDLIN
Middle Name:
Last Name:TALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 BURDETTE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1982
Mailing Address - Country:US
Mailing Address - Phone:313-288-0821
Mailing Address - Fax:248-461-1209
Practice Address - Street 1:1938 BURDETTE ST STE 107
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1982
Practice Address - Country:US
Practice Address - Phone:313-432-8242
Practice Address - Fax:248-461-1209
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
MI6801106771041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program