Individual
PHILLIP EDWARD NIKLOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TLLP
Contact information
Practice address
300 N ELBA RD, LAPEER, MI 48446-8077
(810) 969-4442
Mailing address
2014 KOLLEN ST, SAGINAW, MI 48602-2731
(734) 837-6079
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301017751
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301017751
TEMPORARY LIMITED LICENSED PSYCHOLOGIST
MI
Enumeration date
05/01/2019
Last updated
05/01/2019
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