Healthcare Provider Details

I. General information

NPI: 1073943114
Provider Name (Legal Business Name): MIRJANA PAVKOVIC-BILICIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 MASOTTI CRES.
WINDSOR ONTARIO
N9G2V4
CA

IV. Provider business mailing address

4221 MASOTTI CRES
WINDSOR ONTARIO
N9G2V4
CA

V. Phone/Fax

Practice location:
  • Phone: 586-907-2167
  • Fax:
Mailing address:
  • Phone: 586-907-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12042534
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: