Provider Demographics
NPI:1255840328
Name:SLUGAJ-LUKOWSKI, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SLUGAJ-LUKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:SLUGAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 S JOHNSON ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1662
Mailing Address - Country:US
Mailing Address - Phone:248-333-7222
Mailing Address - Fax:248-333-7254
Practice Address - Street 1:35 S JOHNSON ST STE 3C
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1662
Practice Address - Country:US
Practice Address - Phone:248-333-7222
Practice Address - Fax:248-333-7254
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)