Provider Demographics
NPI:1881945145
Name:ZELAZNY, JOANNE C (LBSW, FSAC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:C
Last Name:ZELAZNY
Suffix:
Gender:F
Credentials:LBSW, FSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20724 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5313
Mailing Address - Country:US
Mailing Address - Phone:734-759-0510
Mailing Address - Fax:734-324-3134
Practice Address - Street 1:20724 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5313
Practice Address - Country:US
Practice Address - Phone:734-759-0510
Practice Address - Fax:734-324-3134
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI6802018901104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)