Provider Demographics
NPI:1649288879
Name:WALKOWSKI, MICHELLE LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:WALKOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:NERKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:960 MITCHELL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48412-9402
Mailing Address - Country:US
Mailing Address - Phone:810-721-0531
Mailing Address - Fax:
Practice Address - Street 1:1170 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4658
Practice Address - Country:US
Practice Address - Phone:810-987-1753
Practice Address - Fax:810-987-1755
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010828311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801082831OtherSTATE OF MICHIGAN, LMSW