Provider Demographics
NPI:1023277522
Name:MIKULICH, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MIKULICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARY REED RD
Mailing Address - Street 2:SUITE A101
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-9612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1607 3RD ST
Practice Address - Street 2:SUITE A101
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2420
Practice Address - Country:US
Practice Address - Phone:724-728-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional