Provider Demographics
NPI:1902247406
Name:REDLAWSK, JOEL TODD
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:TODD
Last Name:REDLAWSK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:TODD
Other - Last Name:REDLAWSK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPSS
Mailing Address - Street 1:304 S. NIAGRA ST.
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1570
Mailing Address - Country:US
Mailing Address - Phone:989-799-6542
Mailing Address - Fax:989-799-6681
Practice Address - Street 1:304 S NIAGARA ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1570
Practice Address - Country:US
Practice Address - Phone:989-799-6542
Practice Address - Fax:989-799-6681
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist