Healthcare Provider Details

I. General information

NPI: 1427402791
Provider Name (Legal Business Name): LINDA VATNIKAJ LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA DJOKAJ LLPC

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N GROESBECK HWY
MOUNT CLEMENS MI
48043-1562
US

IV. Provider business mailing address

52208 HEATHERSTONE AVE
MACOMB MI
48042-3552
US

V. Phone/Fax

Practice location:
  • Phone: 586-627-0024
  • Fax:
Mailing address:
  • Phone: 586-246-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6401018519
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: