Basic Information
| Provider Information | |||||||||
| NPI: | 1548607518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAJDAK | ||||||||
| FirstName: | KELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4122 ALPHA ST | ||||||||
| Address2: | APT 16 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489104750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346266113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4572 S HAGADORN RD | ||||||||
| Address2: | #1C | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174812133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401012822 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.