Provider Demographics
NPI:1255887485
Name:WIKLANSKI, JEREMY (LLPC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:WIKLANSKI
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11861 NORTH RANSOM ROAD
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:MI
Mailing Address - Zip Code:48662-9712
Mailing Address - Country:US
Mailing Address - Phone:989-285-2500
Mailing Address - Fax:
Practice Address - Street 1:11861 NORTH RANSOM ROAD
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:MI
Practice Address - Zip Code:48662-9712
Practice Address - Country:US
Practice Address - Phone:989-285-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional