Healthcare Provider Details

I. General information

NPI: 1295243087
Provider Name (Legal Business Name): ANTHONY F WOZNICKI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16931 19 MILE RD STE 140
CLINTON TOWNSHIP MI
48038-4841
US

IV. Provider business mailing address

16931 19 MILE RD STE 140
CLINTON TOWNSHIP MI
48038-4841
US

V. Phone/Fax

Practice location:
  • Phone: 586-226-2822
  • Fax: 586-226-2833
Mailing address:
  • Phone: 586-226-2822
  • Fax: 586-226-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: