Provider Demographics
NPI:1508091422
Name:SLIVKA, MICHELLE K (BA, LSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:K
Last Name:SLIVKA
Suffix:
Gender:F
Credentials:BA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-1132
Mailing Address - Country:US
Mailing Address - Phone:330-454-7917
Mailing Address - Fax:330-452-0493
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-454-7917
Practice Address - Fax:330-452-0493
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X251B00000X
OHS.0900556104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290822Medicaid