Provider Demographics
NPI:1447969845
Name:SKOCHELAK, SOPHIE (LLMSW)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:SKOCHELAK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5591 N MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-8758
Mailing Address - Country:US
Mailing Address - Phone:734-545-0451
Mailing Address - Fax:
Practice Address - Street 1:8080 MOORSBRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4422
Practice Address - Country:US
Practice Address - Phone:269-795-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851108783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker