Provider Demographics
NPI:1487898763
Name:ZOLECKI-POLZIN, LAUREN MARIE (MA LLP)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:ZOLECKI-POLZIN
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 WOODVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8411
Mailing Address - Country:US
Mailing Address - Phone:815-353-6854
Mailing Address - Fax:
Practice Address - Street 1:5031 PARK LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3835
Practice Address - Country:US
Practice Address - Phone:517-381-1510
Practice Address - Fax:517-332-4452
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013832103T00000X, 103TC0700X
MI6361003059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical