Healthcare Provider Details

I. General information

NPI: 1548173248
Provider Name (Legal Business Name): PAUL IKONEN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 INDIANWOOD RD
LAKE ORION MI
48362-1108
US

IV. Provider business mailing address

1335 JOSLYN RD
LAKE ORION MI
48360-1133
US

V. Phone/Fax

Practice location:
  • Phone: 248-814-1724
  • Fax: 248-814-0209
Mailing address:
  • Phone: 248-693-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: