Provider Demographics
NPI:1649441247
Name:HOPE-RATZLAFF, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HOPE-RATZLAFF
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 1:10782 SPARKLING WATERS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9297
Mailing Address - Country:US
Mailing Address - Phone:248-444-0560
Mailing Address - Fax:248-446-8980
Practice Address - Street 1:208 E MCHATTIE ST
Practice Address - Street 2:STE 106
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1424
Practice Address - Country:US
Practice Address - Phone:248-444-0560
Practice Address - Fax:248-446-8980
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010814011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical