Healthcare Provider Details

I. General information

NPI: 1598253874
Provider Name (Legal Business Name): MRS. MAGGIE PROCHASKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5864 INTERFACE DR STE B
ANN ARBOR MI
48103-9514
US

IV. Provider business mailing address

5864 INTERFACE DR STE B
ANN ARBOR MI
48103-9514
US

V. Phone/Fax

Practice location:
  • Phone: 734-388-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301017415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: