Healthcare Provider Details

I. General information

NPI: 1306344635
Provider Name (Legal Business Name): NATALIA MIEGOC LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIA WILZAK

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W UNIVERSITY DR STE A
ROCHESTER MI
48307-1938
US

IV. Provider business mailing address

410 W UNIVERSITY DR STE A
ROCHESTER MI
48307-1938
US

V. Phone/Fax

Practice location:
  • Phone: 586-229-1559
  • Fax:
Mailing address:
  • Phone: 586-229-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: