Healthcare Provider Details

I. General information

NPI: 1972174100
Provider Name (Legal Business Name): ANGELICA WOZNIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N MICHIGAN AVE
COLDWATER MI
49036-1527
US

IV. Provider business mailing address

90 N MICHIGAN AVE
COLDWATER MI
49036-1527
US

V. Phone/Fax

Practice location:
  • Phone: 708-717-7452
  • Fax:
Mailing address:
  • Phone: 708-717-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152000050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: