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General NPI Number Information
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NPI Number | 1083694848
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Entity Type | Individual
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Provider Name | MICHAEL JOHN LELWICA PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3600 LINCOLN WAY SUITE 4
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City | AMES
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State | IA
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Zip | 50014-7595
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Country | US
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Telephone | 515-239-4410
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Fax | 515-663-4885
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Provider Business Mailing Address
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Address Line | 1314 42ND ST
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City | DES MOINES
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State | IA
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Zip | 50311-2529
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Country | US
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Telephone | 515-279-0830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 00870
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License Number State | IA
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