Provider Demographics
NPI:1538142476
Name:MICHAELS, LINDA SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUZANNE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUZI
Other - Middle Name:
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:679 PLATT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-1707
Mailing Address - Country:US
Mailing Address - Phone:419-697-9797
Mailing Address - Fax:419-697-9754
Practice Address - Street 1:679 PLATT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1707
Practice Address - Country:US
Practice Address - Phone:419-697-9797
Practice Address - Fax:419-697-9754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4766103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000280542OtherANTHEM
OH0960241Medicaid
CP14412Medicare ID - Type Unspecified
000000280542OtherANTHEM