Provider Demographics
NPI:1942427414
Name:WILAMOWSKI, TERRY (MS, LLP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WILAMOWSKI
Suffix:
Gender:M
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 CLARKSTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5213
Mailing Address - Country:US
Mailing Address - Phone:734-454-3560
Mailing Address - Fax:248-391-7478
Practice Address - Street 1:340 N MAIN ST
Practice Address - Street 2:SUITE 318
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1249
Practice Address - Country:US
Practice Address - Phone:734-454-3560
Practice Address - Fax:248-391-7478
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010495103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist