Provider Demographics
NPI:1730709734
Name:MICHALIK, EMILY MARSHALL (MED)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARSHALL
Last Name:MICHALIK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-0853
Mailing Address - Country:US
Mailing Address - Phone:312-813-1662
Mailing Address - Fax:
Practice Address - Street 1:289 MONTANA LANDING
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5986
Practice Address - Country:US
Practice Address - Phone:312-813-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNONE