Provider Demographics
NPI:1790930584
Name:WITZKE, ONIKA LEESA (LMSW)
Entity Type:Individual
Prefix:
First Name:ONIKA
Middle Name:LEESA
Last Name:WITZKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ONIKA
Other - Middle Name:L
Other - Last Name:SOWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:HONOR
Mailing Address - State:MI
Mailing Address - Zip Code:49640-0175
Mailing Address - Country:US
Mailing Address - Phone:231-680-4555
Mailing Address - Fax:
Practice Address - Street 1:10524 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONOR
Practice Address - State:MI
Practice Address - Zip Code:49640-9461
Practice Address - Country:US
Practice Address - Phone:231-680-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086185104100000X
MI6801092996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker