Provider Demographics
NPI:1508255969
Name:OLEKSIAK, KATHERINE MARY (LLMSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:OLEKSIAK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25912 ANNAPOLIS ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3201
Mailing Address - Country:US
Mailing Address - Phone:313-565-2174
Mailing Address - Fax:
Practice Address - Street 1:25912 ANNAPOLIS ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3201
Practice Address - Country:US
Practice Address - Phone:313-565-2174
Practice Address - Fax:313-565-2189
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010917641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical