Provider Demographics
NPI:1669412045
Name:WRATKOWSKI, JAMES A (LMSW, BCD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:WRATKOWSKI
Suffix:
Gender:M
Credentials:LMSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W. UNIVERSITY DR.
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1876
Mailing Address - Country:US
Mailing Address - Phone:248-923-2099
Mailing Address - Fax:248-923-2096
Practice Address - Street 1:1000 W. UNIVERSITY DR.
Practice Address - Street 2:SUITE 308
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1876
Practice Address - Country:US
Practice Address - Phone:248-923-2099
Practice Address - Fax:248-923-2096
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801001379104100000X
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7581006Medicare UPIN
MIQ26426007Medicare ID - Type Unspecified
MIMI7581Medicare PIN
MIS06188Medicare UPIN