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Individual
MRS. PAULA KATHLEEN WIETRZYKOWSKI
Active
Individual
MRS. PAULA KATHLEEN WIETRZYKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.S.W.
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801081581
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0897371
BLUE CROSS BLUE SHIELD
MI
01
—
383322171
TAX ID
MI
Enumeration date
05/16/2006
Last updated
03/04/2008
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