| Life Skills Village, Pllc | |
|
25900 Greenfield Rd Suite 100 Oak Park MI 48237-1292 | |
| (248) 788-4300 | |
| (248) 605-8099 |
| Full Name | Life Skills Village, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 25900 Greenfield Rd, Oak Park, Michigan |
| Authorized Official Name and Position | Nate Gardin (COO) |
| Authorized Official Contact | 2487884300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Skills Village, Pllc 20010 Farmington Rd Livonia MI 48152-1408 Ph: (248) 788-4300 | Life Skills Village, Pllc 25900 Greenfield Rd Suite 100 Oak Park MI 48237-1292 Ph: (248) 788-4300 |
| NPI Number | 1629316815 |
|---|---|
| Provider Enumeration Date | 01/22/2013 |
| Last Update Date | 02/12/2020 |
| Certification Date | 02/12/2020 |
| Medicare PECOS PAC ID | 2860624103 |
|---|---|
| Medicare Enrollment ID | O20140421000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629316815 | NPI | - | NPPES |
| Provider Name | David Michael Cowan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124106398 PECOS PAC ID: 0648285080 Enrollment ID: I20060207000421 |
| Provider Name | Michelle K Klaty |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114104601 PECOS PAC ID: 4082632823 Enrollment ID: I20110907000830 |
| Provider Name | Jeffrey D Wilbur |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700216975 PECOS PAC ID: 6002030202 Enrollment ID: I20140609001919 |
| Provider Name | Amy L Lipple |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1255798062 PECOS PAC ID: 7113211673 Enrollment ID: I20160805000413 |
| Provider Name | Destiny L Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154865590 PECOS PAC ID: 1153687348 Enrollment ID: I20171103000404 |
| Provider Name | Terese O'rourke |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346697745 PECOS PAC ID: 2365854056 Enrollment ID: I20201222002753 |
| Provider Name | Andrea Dell |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366868515 PECOS PAC ID: 7416354295 Enrollment ID: I20210921002296 |
| Provider Name | Matthew J Horne |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1639789092 PECOS PAC ID: 5698172476 Enrollment ID: I20210921002323 |
| Provider Name | Jenna Suzio |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1962094151 PECOS PAC ID: 7618354788 Enrollment ID: I20220510002028 |
| Provider Name | Alissia Wells |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497479042 PECOS PAC ID: 2961878723 Enrollment ID: I20221019000891 |
| Provider Name | Katrina Langen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598526097 PECOS PAC ID: 9739522343 Enrollment ID: I20240212001184 |
| Provider Name | Camille Haslinger |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1194295287 PECOS PAC ID: 8527402700 Enrollment ID: I20240215001402 |
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