Provider Demographics
NPI:1508464892
Name:SLEDZ, STACY MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:SLEDZ
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 1:19499 DOYLE RD
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:MI
Mailing Address - Zip Code:48137-9801
Mailing Address - Country:US
Mailing Address - Phone:734-260-1918
Mailing Address - Fax:
Practice Address - Street 1:19499 DOYLE RD
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:MI
Practice Address - Zip Code:48137-9801
Practice Address - Country:US
Practice Address - Phone:734-260-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010968961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical