MEDICARE: CASEY SLAGER MA, LLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6451017699	MI

General Provider Information

NPI Number	:	1386273225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY SLAGER MA, LLPC

Provider Business Mailing Address
First Line	:	120 LANARK CT
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-4357
Country	:	US
Telephone Number	:	269-370-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 W MAIN ST STE 100
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-3731
Country	:	US
Telephone Number	:	269-370-5108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	08/11/2021

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