Provider Demographics
NPI:1972143832
Name:POLLOCK, MICHAELA B
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:B
Last Name:POLLOCK
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 1:816 W MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-7501
Mailing Address - Country:US
Mailing Address - Phone:701-352-4444
Mailing Address - Fax:
Practice Address - Street 1:816 W MIDWAY DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-7501
Practice Address - Country:US
Practice Address - Phone:701-352-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
SD061-ABA103K00000X
MN1-19-40300103K00000X
NDL75103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst