Healthcare Provider Details

I. General information

NPI: 1932520970
Provider Name (Legal Business Name): ALICIA KOCHAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA BIANCHETTE

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37400 GARFIELD RD STE 130
CLINTON TWP MI
48036-3648
US

IV. Provider business mailing address

40612 REHSE DR
CLINTON TWP MI
48038-4136
US

V. Phone/Fax

Practice location:
  • Phone: 586-738-6518
  • Fax:
Mailing address:
  • Phone: 586-549-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851118719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: