Provider Demographics
NPI:1578353579
Name:GOWDA, ANIKA
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:GOWDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANIKA
Other - Middle Name:
Other - Last Name:PUTTAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7025 E MICHIGAN AVE STE J
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9479
Mailing Address - Country:US
Mailing Address - Phone:313-278-4601
Mailing Address - Fax:
Practice Address - Street 1:7025 E MICHIGAN AVE STE J
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9479
Practice Address - Country:US
Practice Address - Phone:313-278-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician