Active NPI
Phillip Edward Niklowicz, TLLP
- Clinical Psychologist
- Lapeer, MI
National Provider Identifier
1093379414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301017751
- Practice address
- 300 N Elba Rd
Lapeer, MI 48446-8077 - Phone
- (810) 969-4442
- NPI assigned
- May 1, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301017751 | MI | Primary |
Addresses
Primary practice location
300 N Elba Rd
Lapeer, MI 48446-8077
Mailing address
2014 Kollen St
Saginaw, MI 48602-2731
Phone (734) 837-6079
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6301017751 | Other | MI | TEMPORARY LIMITED LICENSED PSYCHOLOGIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301017751 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556668800000",
"number": "1093379414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2014 KOLLEN ST",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486022731",
"telephone_number": "734-837-6079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N ELBA RD",
"city": "LAPEER",
"state": "MI",
"postal_code": "484468077",
"telephone_number": "810-969-4442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKLOWICZ",
"first_name": "PHILLIP",
"middle_name": "EDWARD",
"credential": "TLLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-01",
"last_updated": "2019-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301017751",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEMPORARY LIMITED LICENSED PSYCHOLOGIST",
"identifier": "6301017751",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lapeer, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.