Provider Demographics
NPI:1306344635
Name:MIEGOC, NATALIA (LMSW)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:MIEGOC
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:WILZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2776 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1601
Mailing Address - Country:US
Mailing Address - Phone:586-625-2730
Mailing Address - Fax:
Practice Address - Street 1:33493 W 14 MILE RD STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1587
Practice Address - Country:US
Practice Address - Phone:248-851-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011140481041C0700X
MI6801105554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker