Provider Demographics
NPI:1982013504
Name:KRAHULEC, SHIRLANN VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:SHIRLANN
Middle Name:VICTORIA
Last Name:KRAHULEC
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 1:43895 CADBURRY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1442
Mailing Address - Country:US
Mailing Address - Phone:586-713-9316
Mailing Address - Fax:
Practice Address - Street 1:37400 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3648
Practice Address - Country:US
Practice Address - Phone:586-738-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982013504Medicaid
MI1982013504OtherMI