1306037551 NPI number — MS. KELLY KRISTINE MANSON LMSW

Table of content: MS. KELLY KRISTINE MANSON LMSW (NPI 1306037551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306037551 NPI number — MS. KELLY KRISTINE MANSON LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSON
Provider First Name:
KELLY
Provider Middle Name:
KRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRANKOWSKI-HARRISON
Provider Other First Name:
KELLY
Provider Other Middle Name:
KRISTINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306037551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22849 SHERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSTOWN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48134-9064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-552-0992
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 MIDDLEBELT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROMULUS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48174-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-344-0069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801089395 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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