Healthcare Provider Details

I. General information

NPI: 1144627480
Provider Name (Legal Business Name): STEPHANIE ANNA WOZNIAK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD
TROY MI
48084-4736
US

IV. Provider business mailing address

888 W BIG BEAVER RD
TROY MI
48084-4736
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-8644
  • Fax:
Mailing address:
  • Phone: 248-244-8644
  • Fax: 248-244-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091308
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: