Healthcare Provider Details

I. General information

NPI: 1538582671
Provider Name (Legal Business Name): LAURA ANN WYGLINSKI, PH. D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2014
Last Update Date: 01/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 OKEMOS RD
OKEMOS MI
48864-1974
US

IV. Provider business mailing address

4200 WAINWRIGHT AVE
LANSING MI
48911-2248
US

V. Phone/Fax

Practice location:
  • Phone: 517-483-3081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA ANN WYGLINSKI
Title or Position: PSYCHOLOGIST LLP
Credential:
Phone: 517-483-3081