Provider Demographics
NPI:1265661581
Name:WIERMAN, MICKI R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICKI
Middle Name:R
Last Name:WIERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MICKI
Other - Middle Name:R
Other - Last Name:KLUNGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:102 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2202
Mailing Address - Country:US
Mailing Address - Phone:248-531-8381
Mailing Address - Fax:
Practice Address - Street 1:102 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2202
Practice Address - Country:US
Practice Address - Phone:248-531-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist