Individual
MRS. MARIA KANISZEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2715 S TOWNLINE RD, HOUGHTON LAKE, MI 48629-9294
(989) 366-1118
(989) 366-9420
Mailing address
2715 S TOWNLINE RD, HOUGHTON LAKE, MI 48629-9294
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
L1764585
MI
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
L1815378
MI
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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