Provider Demographics
NPI:1558584276
Name:CARLEY KACZYNSKI, DANA DEE
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:DEE
Last Name:CARLEY KACZYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:126 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5846
Practice Address - Country:US
Practice Address - Phone:989-684-7977
Practice Address - Fax:989-684-4331
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010785301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical