Healthcare Provider Details

I. General information

NPI: 1396655304
Provider Name (Legal Business Name): ISABELLA PROHASKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E HARRY AVE
HAZEL PARK MI
48030-2152
US

IV. Provider business mailing address

1620 E ELZA AVE # 2358
HAZEL PARK MI
48030-2358
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-2400
  • Fax:
Mailing address:
  • Phone: 248-658-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851115995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: