Healthcare Provider Details

I. General information

NPI: 1104883958
Provider Name (Legal Business Name): BOZENA TERESA STRAK-WARREN FLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6818
US

IV. Provider business mailing address

812 E JOLLY RD STE 311
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8265
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-346-8410
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009784
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: