Provider Demographics
NPI:1326715079
Name:MISOVSKA, SAMANTHA KAITLYN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAITLYN
Last Name:MISOVSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19774 NOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5923
Mailing Address - Country:US
Mailing Address - Phone:586-305-0676
Mailing Address - Fax:
Practice Address - Street 1:42850 GARFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5026
Practice Address - Country:US
Practice Address - Phone:586-295-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician