1134378979 NPI number — MICHALOSKI WILSON & ASSOC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134378979 NPI number — MICHALOSKI WILSON & ASSOC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHALOSKI WILSON & ASSOC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1134378979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8815 ALNWICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-882-7820
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 E. JOPPA RD
Provider Second Line Business Practice Location Address:
SUITE LL8
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-882-0470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VICE PRESIDENT/PSYCHOTHERAPIST
Authorized Official Telephone Number:
410-882-0470

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  46804 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC0034 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LL09M1 . This is a "BLUE CROSS/SHIELD OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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