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General NPI Number Information
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NPI Number | 1457198590
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Entity Type | Individual
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Provider Name | MICHAELA JANE SLEZAK
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Gender | Female
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1401 21ST ST STE 8122
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 805-910-7455
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Fax | 805-910-7455
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Provider Business Mailing Address
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Address Line | 1001 FREMONT AVE # 3393
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3224
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Country | US
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Telephone | 623-565-1913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 120288
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License Number State | CA
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