1669412045 NPI number — MR. JAMES A WRATKOWSKI LMSW, BCD

Table of content: MR. JAMES A WRATKOWSKI LMSW, BCD (NPI 1669412045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669412045 NPI number — MR. JAMES A WRATKOWSKI LMSW, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRATKOWSKI
Provider First Name:
JAMES
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, BCD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669412045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W. UNIVERSITY DR.
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-1876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-923-2099
Provider Business Mailing Address Fax Number:
248-923-2096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W. UNIVERSITY DR.
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-1876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-923-2099
Provider Business Practice Location Address Fax Number:
248-923-2096
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801001379 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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