Individual
NICOLE WOZNIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
409 PLYMOUTH RD STE 250, PLYMOUTH, MI 48170
(734) 416-9098
Mailing address
42736 SWAN LAKE DR APT 204, NORTHVILLE, MI 48167-3114
(586) 453-4539
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSYPAT00218240
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
08/20/2015
Last updated
11/28/2018
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