Healthcare Provider Details

I. General information

NPI: 1396266672
Provider Name (Legal Business Name): KELSEY MARIE SLAGLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15173 NORTH RD STE 100
FENTON MI
48430-1381
US

IV. Provider business mailing address

2824 ONAGON TRL
WATERFORD MI
48328-3139
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-4074
  • Fax: 810-866-4450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121448
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: