Provider Demographics
NPI:1245614395
Name:WILSON, MICHELE E (MS, LLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:E
Other - Last Name:COWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6425 SCHAEFER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6425 SCHAEFER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-846-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical