Provider Demographics
NPI:1811558216
Name:MICOL, VALERIE (MS)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MICOL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 E WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2057
Mailing Address - Country:US
Mailing Address - Phone:734-764-3471
Mailing Address - Fax:
Practice Address - Street 1:210 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2216
Practice Address - Country:US
Practice Address - Phone:734-764-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017603390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program