Individual
DR. MICHELLE MARIE MICSKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
515 HILLCREST RD E, LAKE QUIVIRA, KS 66217-8782
(913) 631-3800
(913) 948-7317
Mailing address
515 HILLCREST RD E, LAKE QUIVIRA, KS 66217-8782
(913) 631-3800
(913) 948-7317
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0818
KS
103TC0700X
Clinical Psychologist
PY01595
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255098349
NPI
—
Enumeration date
09/13/2006
Last updated
11/23/2021
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