Provider Demographics
NPI:1457954448
Name:POLANSKI, REBECCA (MA, TLLP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:POLANSKI
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 HALL RD STE 209
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5554
Mailing Address - Country:US
Mailing Address - Phone:586-286-5870
Mailing Address - Fax:586-286-5834
Practice Address - Street 1:8344 HALL RD STE 209
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5554
Practice Address - Country:US
Practice Address - Phone:586-286-5870
Practice Address - Fax:586-286-5834
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist