Provider Demographics
NPI:1124530688
Name:GORETZKA, SHAELES MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SHAELES
Middle Name:MARIE
Last Name:GORETZKA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:
Other - Last Name:GORETZKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5212 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3839
Mailing Address - Country:US
Mailing Address - Phone:269-352-0082
Mailing Address - Fax:
Practice Address - Street 1:1608 LAKE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3170
Practice Address - Country:US
Practice Address - Phone:269-270-2367
Practice Address - Fax:269-344-0285
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010972631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical