Provider Demographics
NPI:1144356569
Name:SEASLY, MICHELE ANN (ACSW CAC1 LMSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:SEASLY
Suffix:
Gender:F
Credentials:ACSW CAC1 LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1939 S DIVISION
Mailing Address - Street 2:FAMILY OUTREACH CENTER
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507
Mailing Address - Country:US
Mailing Address - Phone:616-247-3815
Mailing Address - Fax:616-245-0450
Practice Address - Street 1:1939 S DIVISION
Practice Address - Street 2:FAMILY OUTREACH CENTER
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507
Practice Address - Country:US
Practice Address - Phone:616-247-3815
Practice Address - Fax:616-245-0450
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD16322Medicare ID - Type Unspecified