Provider Demographics
NPI:1154087039
Name:GAWLAK-KLUMP, MONIKA
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:GAWLAK-KLUMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 DOBLER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MI
Mailing Address - Zip Code:48659-9764
Mailing Address - Country:US
Mailing Address - Phone:989-313-1560
Mailing Address - Fax:
Practice Address - Street 1:1182 DOBLER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9764
Practice Address - Country:US
Practice Address - Phone:989-313-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician