MEDICARE: MR. KEVIN B STACHOWIAK LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801095065	MI

General Provider Information

NPI Number	:	1598877714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN B STACHOWIAK LMSW

Provider Business Mailing Address
First Line	:	10751 S SAGINAW ST STE L
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8169
Country	:	US
Telephone Number	:	810-691-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	10751 S SAGINAW ST STE L
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8169
Country	:	US
Telephone Number	:	866-227-2708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	04/19/2024

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