Basic Information
Provider Information | |||||||||
NPI: | 1912057928 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STRZALKOWSKI | ||||||||
FirstName: | SHELLEY | ||||||||
MiddleName: | LINN-ADLER | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA, LLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ADLER | ||||||||
OtherFirstName: | SHELLEY | ||||||||
OtherMiddleName: | LINN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MA, LLP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2280 E GRAND RIVER AVE | ||||||||
Address2: |   | ||||||||
City: | HOWELL | ||||||||
State: | MI | ||||||||
PostalCode: | 488438503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5175464126 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2280 E GRAND RIVER AVE | ||||||||
Address2: |   | ||||||||
City: | HOWELL | ||||||||
State: | MI | ||||||||
PostalCode: | 488438503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5175464126 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/11/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301010729 | MI | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.