Healthcare Provider Details

I. General information

NPI: 1306759352
Provider Name (Legal Business Name): ALLYSON WEGLARZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 60
ROCHESTER HILLS MI
48309-1729
US

IV. Provider business mailing address

24725 W 12 MILE RD STE 115
SOUTHFIELD MI
48034-8345
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-4515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025352
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: