Provider Demographics
NPI:1467965566
Name:STAVISKI, JANELLE E (LMSW)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:E
Last Name:STAVISKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9611 CEMENT CITY HWY
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:MI
Mailing Address - Zip Code:49220-9723
Mailing Address - Country:US
Mailing Address - Phone:616-881-6042
Mailing Address - Fax:517-998-0005
Practice Address - Street 1:207 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2102
Practice Address - Country:US
Practice Address - Phone:517-998-4673
Practice Address - Fax:517-998-0005
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010956731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical