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NPI Code Detail

MEDICARE: MARISA ANN SCHONGALLA PSY.D.

MEDICARE: MARISA ANN SCHONGALLA PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6301012822MI

General Provider Information

NPI Number : 1790717395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA ANN SCHONGALLA PSY.D.
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number : 517-492-0784
Fax Number : 734-737-1205
Provider Business Practice Location Address
First Line : 5958 N CANTON CENTER RD STE 900
Second Line :
City : CANTON
State : MI
Zip : 48187-2740
Country : US
Telephone Number : 517-492-0784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 07/07/2025

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