Provider Demographics
NPI:1932083201
Name:REDKO, NICOLE (MA LLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:REDKO
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 BAKER CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5448
Mailing Address - Country:US
Mailing Address - Phone:248-797-5118
Mailing Address - Fax:
Practice Address - Street 1:3121 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4606
Practice Address - Country:US
Practice Address - Phone:248-564-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist