Provider Demographics
NPI:1033855812
Name:HODGES-PIETRYKA, MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HODGES-PIETRYKA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18625 INNSBROOK DR APT 2
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2428
Mailing Address - Country:US
Mailing Address - Phone:989-325-0141
Mailing Address - Fax:
Practice Address - Street 1:1500 WEISS ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5251
Practice Address - Country:US
Practice Address - Phone:989-497-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical