Provider Demographics
NPI:1669501326
Name:OPALKA, SHERRY L (LMSW AND LPC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:OPALKA
Suffix:
Gender:F
Credentials:LMSW AND LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19254
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49019-0254
Mailing Address - Country:US
Mailing Address - Phone:269-345-2621
Mailing Address - Fax:
Practice Address - Street 1:821 W SOUTH ST STE C
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4664
Practice Address - Country:US
Practice Address - Phone:269-345-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00738101YA0400X
MI6401004533101YP2500X
MI68010592351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008918420OtherBLUE CROSS BLUE SHIELD
MI0M81460Medicare ID - Type UnspecifiedMEDICARE