Provider Demographics
NPI:1861725814
Name:REA-MICHALAK, NATALIE ROSE (LLP, LLMSW)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ROSE
Last Name:REA-MICHALAK
Suffix:
Gender:F
Credentials:LLP, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47378 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4783
Mailing Address - Country:US
Mailing Address - Phone:586-495-4704
Mailing Address - Fax:
Practice Address - Street 1:43900 GARFIELD RD STE 222
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1137
Practice Address - Country:US
Practice Address - Phone:586-263-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014258103TC0700X
MI68010891291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical