Provider Demographics
NPI:1396598041
Name:ZYGELMAN, SHOSHANA RUTH (TLLP, LLC)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:RUTH
Last Name:ZYGELMAN
Suffix:
Gender:F
Credentials:TLLP, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 ORCHARD LAKE RD # 1058
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3794
Mailing Address - Country:US
Mailing Address - Phone:248-978-5574
Mailing Address - Fax:
Practice Address - Street 1:33505 SCHOOLCRAFT RD,#3, LIVONIA, MI 48150
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-978-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009899103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation