Provider Information for 1972922516
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CHALICE M KOPACKI LMSW, MPA
Sex: Female
NPI: 1972922516
Last Updated: 2018-09-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972922516 | ||||||||
| Enumeration Date | 2014-04-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3785 BAY RD SAGINAW, MI 48603-2433 United States Phone: 989-791-2455 | Fax:989-791-1392 | ||||||||
| Primary Practice Address | 4020 COPPER VW STE 104 TRAVERSE CITY, MI 49684 United States Phone: 231-421-6921 | Fax:231-421-7852 | ||||||||
| Secondary Practice Address(es) | 550 MUNSON AVE | ||||||||
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