Provider Demographics
NPI:1457198590
Name:SLEZAK, MICHAELA JANE
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:JANE
Last Name:SLEZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 FREMONT AVE # 3393
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3224
Mailing Address - Country:US
Mailing Address - Phone:623-565-1913
Mailing Address - Fax:
Practice Address - Street 1:1401 21ST ST STE 8122
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5226
Practice Address - Country:US
Practice Address - Phone:805-910-7455
Practice Address - Fax:805-910-7455
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker