Provider Demographics
NPI:1558808493
Name:MASCHALKO, KARLA (TLLP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:MASCHALKO
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 CLIFFS LNDG APT 5
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7328
Mailing Address - Country:US
Mailing Address - Phone:734-709-7716
Mailing Address - Fax:
Practice Address - Street 1:1741 CLIFFS LNDG APT 5
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-7328
Practice Address - Country:US
Practice Address - Phone:734-709-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016369103T00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist