Provider Demographics
NPI:1861547481
Name:PULA-JUREK, VICKI LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:PULA-JUREK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 NORTH M-65
Mailing Address - Street 2:
Mailing Address - City:TWINING
Mailing Address - State:MI
Mailing Address - Zip Code:48766
Mailing Address - Country:US
Mailing Address - Phone:989-867-4262
Mailing Address - Fax:989-867-4334
Practice Address - Street 1:1171 NORTH HALE ROAD
Practice Address - Street 2:
Practice Address - City:TWINING
Practice Address - State:MI
Practice Address - Zip Code:48766-9793
Practice Address - Country:US
Practice Address - Phone:989-867-4262
Practice Address - Fax:989-867-4334
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010601411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0894289OtherBLUE CROSS BLUE SHIE PIN
MI096298OtherVALUE OPTIONS