Provider Demographics
NPI:1356940969
Name:MICKI R WIERMAN PHD PLLC
Entity type:Organization
Organization Name:MICKI R WIERMAN PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-531-8381
Mailing Address - Street 1:102 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2202
Mailing Address - Country:US
Mailing Address - Phone:248-531-8381
Mailing Address - Fax:
Practice Address - Street 1:102 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2202
Practice Address - Country:US
Practice Address - Phone:248-531-8381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty