Provider Demographics
NPI:1396496618
Name:KLESZ, TAWNY RENE (LLMSW)
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:RENE
Last Name:KLESZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 E 12 MILE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4200
Mailing Address - Country:US
Mailing Address - Phone:810-772-8836
Mailing Address - Fax:
Practice Address - Street 1:1710 E 12 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4200
Practice Address - Country:US
Practice Address - Phone:810-772-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical