Healthcare Provider Details

I. General information

NPI: 1053084178
Provider Name (Legal Business Name): TRISHA ZUKOWSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34625 BRIDGEMAN ST
FARMINGTON HILLS MI
48335-4625
US

IV. Provider business mailing address

34625 BRIDGEMAN ST
FARMINGTON HILLS MI
48335-4625
US

V. Phone/Fax

Practice location:
  • Phone: 248-909-5544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: