Provider Demographics
NPI:1942699590
Name:LASKOWSKI, KELSEY ROSE (TLLP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ROSE
Last Name:LASKOWSKI
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 KATALIN CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2161
Mailing Address - Country:US
Mailing Address - Phone:989-671-0866
Mailing Address - Fax:
Practice Address - Street 1:3707 KATALIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2161
Practice Address - Country:US
Practice Address - Phone:989-671-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016187103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist