Provider Demographics
NPI:1891200374
Name:MIKKELSON, JUNE M (MS, CGC)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:M
Last Name:MIKKELSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:M
Other - Last Name:MALKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:ROSWELL PARK CANCER INSTITUTE C&V 233
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-8400
Mailing Address - Fax:716-845-5720
Practice Address - Street 1:ROSWELL PARK CANCER INSTITUTE C&V 233
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-8400
Practice Address - Fax:716-845-5720
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS