Provider Demographics
NPI:1275866071
Name:MALEWSKI, KELLIE NICOLE (LMSW, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:NICOLE
Last Name:MALEWSKI
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:NICOLE
Other - Last Name:CRITES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW, CAADC
Mailing Address - Street 1:5401 MCAULEY DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-786-2328
Mailing Address - Fax:
Practice Address - Street 1:5401 MCAULEY DR.
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-786-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI6801092195104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid