Healthcare Provider Details

I. General information

NPI: 1447431242
Provider Name (Legal Business Name): STEPHANIE STASIAK LMSW,ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

23956 STACEY DR
BROWNSTOWN MI
48183-5451
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5058
  • Fax:
Mailing address:
  • Phone: 734-558-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801061728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: