Healthcare Provider Details

I. General information

NPI: 1811345085
Provider Name (Legal Business Name): LAURA MARIE SANDY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LAURA MARIE GEIERSBACH

II. Dates (important events)

Enumeration Date: 05/28/2016
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

IV. Provider business mailing address

1805 PRAIRIE ST
ESSEXVILLE MI
48732-1449
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-9661
  • Fax:
Mailing address:
  • Phone: 989-414-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801111302
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: