Provider Demographics
NPI:1609105717
Name:MICHALIK, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MICHALIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6066 STRATHMOOR DR STE 3C
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6633
Mailing Address - Country:US
Mailing Address - Phone:815-397-7330
Mailing Address - Fax:815-399-9306
Practice Address - Street 1:6066 STRATHMOOR DR STE 3C
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6633
Practice Address - Country:US
Practice Address - Phone:815-397-7330
Practice Address - Fax:815-399-9306
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003251103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical