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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X6301010729MIY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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