Healthcare Provider Details

I. General information

NPI: 1508297714
Provider Name (Legal Business Name): AUTUMN CICHOWSKI LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

9095 OVERLAND TRL
FLUSHING MI
48433-1224
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: