Provider Demographics
NPI:1679210215
Name:FRANCKOWIAK, MIKAYLA LARAY
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LARAY
Last Name:FRANCKOWIAK
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 1:120 DEAN ST APT 210A
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2770
Mailing Address - Country:US
Mailing Address - Phone:801-819-1201
Mailing Address - Fax:
Practice Address - Street 1:120 DEAN ST APT 210A
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2770
Practice Address - Country:US
Practice Address - Phone:801-819-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health