MEDICARE: KELSEY MARIE SLAGLE LMSW

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	1041C0700X	Clinical Social Worker	6801121448	MI

General Provider Information

NPI Number	:	1396266672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MARIE SLAGLE LMSW

Provider Business Mailing Address
First Line	:	2824 ONAGON TRL
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-3139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15173 NORTH RD STE 100
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1381
Country	:	US
Telephone Number	:	810-771-4074
Fax Number	:	810-866-4450

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

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	12/19/2025

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