Provider Demographics
NPI:1902812720
Name:BERDESKI, AUDREY (DC, LPC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BERDESKI
Suffix:
Gender:F
Credentials:DC, LPC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:BERDESKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:41400 DEQUINDRE RD
Mailing Address - Street 2:#107
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3763
Mailing Address - Country:US
Mailing Address - Phone:586-466-5911
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD
Practice Address - Street 2:#107
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3763
Practice Address - Country:US
Practice Address - Phone:586-466-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005380111N00000X
MI6401011113101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3147964Medicaid
MI0E05234Medicare ID - Type Unspecified
MI3147964Medicaid