Provider Demographics
NPI:1902591258
Name:THAYER, TRISHA LYNN (CPSS, CPRC)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNN
Last Name:THAYER
Suffix:
Gender:F
Credentials:CPSS, CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34290 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3051
Mailing Address - Country:US
Mailing Address - Phone:313-396-5300
Mailing Address - Fax:
Practice Address - Street 1:34290 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3051
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist