Healthcare Provider Details

I. General information

NPI: 1891124913
Provider Name (Legal Business Name): MELANIE GWIZDALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S SAGINAW ST
FLINT MI
48503-3705
US

IV. Provider business mailing address

1402 S SAGINAW ST
FLINT MI
48503-3705
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3777
  • Fax:
Mailing address:
  • Phone: 810-257-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: