Maria Kaniszewski

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

L1815378 Issued in MI

Practice address

2715 S Townline Rd
Houghton Lake, MI 48629-9294

Phone

(989) 366-1118

Fax

(989) 366-9420

NPI assigned

Oct 1, 2010

Last updated

Oct 1, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285891200000",
    "number": "1740599216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 S TOWNLINE RD",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 S TOWNLINE RD",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299294",
            "telephone_number": "989-366-1118",
            "fax_number": "989-366-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANISZEWSKI",
        "first_name": "MARIA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-01",
        "last_updated": "2010-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "L1764585",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "L1815378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Howard
• Amber Huff, LLBSW
• Charles Hughes
• Imperium Home Care,LLC
• Jay Carl Jenkins, OD
• Heather King
• Nicole Kowalewski, MSW
• Christine Margaret Lee, LBSW/QMRP/QMHP
• Lincare Inc.
• Joshua Thurman Linton, AT,ATC

• Clinical Child & Adolescent Psychologist in Houghton Lake, MI
• Providers in Houghton Lake, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.