=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396266672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY MARIE SLAGLE LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2017
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15173 NORTH RD STE 100
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48430-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-771-4074
-----------------------------------------------------
Fax | 810-866-4450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2824 ONAGON TRL
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48328-3139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801121448
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------