Provider Demographics
NPI:1285350132
Name:HUZIAK, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HUZIAK
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 1:207 VAN NEST ST
Mailing Address - Street 2:APT
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131
Mailing Address - Country:US
Mailing Address - Phone:734-799-1106
Mailing Address - Fax:
Practice Address - Street 1:207 VAN NEST ST
Practice Address - Street 2:APT 7
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131
Practice Address - Country:US
Practice Address - Phone:734-799-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst