Provider Demographics
NPI:1780357707
Name:KREMKUS, ALLEGRA (LMSW)
Entity type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:
Last Name:KREMKUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALLEGRA
Other - Middle Name:
Other - Last Name:RECKNAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8469 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3640
Mailing Address - Country:US
Mailing Address - Phone:248-318-4479
Mailing Address - Fax:
Practice Address - Street 1:4572 S HAGADORN RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-481-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011065641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical