Provider Demographics
NPI:1467169045
Name:LEVANDOSKI, MICHAEL (SAC-IT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LEVANDOSKI
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1211 LAKEVIEW LN LOT 23
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53178-9795
Mailing Address - Country:US
Mailing Address - Phone:920-342-0542
Mailing Address - Fax:
Practice Address - Street 1:325 SENTINEL DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7551
Practice Address - Country:US
Practice Address - Phone:262-549-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18276-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)