Provider Demographics
NPI:1780300798
Name:MIKULKA, SONNIE J (BSW)
Entity type:Individual
Prefix:MS
First Name:SONNIE
Middle Name:J
Last Name:MIKULKA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 BOARDMAN CANFIELD RD STE C4
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4367
Mailing Address - Country:US
Mailing Address - Phone:855-292-9778
Mailing Address - Fax:855-292-9778
Practice Address - Street 1:1344 5TH AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1703
Practice Address - Country:US
Practice Address - Phone:855-292-9778
Practice Address - Fax:855-292-9778
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker