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General NPI Number Information
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NPI Number | 1770110470
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Entity Type | Organization
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Legal Business Name | GAIL KIACZ LMSW LLC
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 120 W EXCHANGE ST STE 3-6
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City | OWOSSO
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State | MI
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Zip | 48867-2834
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Country | US
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Telephone | 989-494-3105
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Fax |
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Provider Business Mailing Address
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Address Line | 9710 E LYTLE RD
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City | LENNON
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State | MI
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Zip | 48449-9753
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAIL KIACZ
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Credential |
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Telephone | 810-691-1114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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