Provider Demographics
NPI:1518600717
Name:KELLY TRAWCZYNSKI
Entity Type:Organization
Organization Name:KELLY TRAWCZYNSKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER IN SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAWCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-606-2673
Mailing Address - Street 1:5399 MIRAGE CIR
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9302
Mailing Address - Country:US
Mailing Address - Phone:616-606-2673
Mailing Address - Fax:
Practice Address - Street 1:5399 MIRAGE CIR
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-9302
Practice Address - Country:US
Practice Address - Phone:616-606-2673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty