Healthcare Provider Details

I. General information

NPI: 1780170183
Provider Name (Legal Business Name): MICHELLE ANN WOJTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 CEDAR LAKE RD
OSCODA MI
48750-9499
US

IV. Provider business mailing address

5805 CEDAR LAKE RD
OSCODA MI
48750-9499
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-1469
  • Fax: 989-739-9901
Mailing address:
  • Phone: 989-739-1469
  • Fax: 989-739-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: