Provider Demographics
NPI:1154869253
Name:TOLIVER-CLEGG, LALITA R
Entity type:Individual
Prefix:
First Name:LALITA
Middle Name:R
Last Name:TOLIVER-CLEGG
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 1:51284 E BOURNE TER
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1010
Mailing Address - Country:US
Mailing Address - Phone:734-968-1010
Mailing Address - Fax:248-927-5110
Practice Address - Street 1:51284 E BOURNE TER
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1010
Practice Address - Country:US
Practice Address - Phone:734-968-1010
Practice Address - Fax:248-927-5110
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide