Healthcare Provider Details

I. General information

NPI: 1457256562
Provider Name (Legal Business Name): SARAH KOURTJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SYLVESTER AVE
BERRIEN SPRINGS MI
49103
US

IV. Provider business mailing address

50669 REBECCA DR
PAW PAW MI
49079-8586
US

V. Phone/Fax

Practice location:
  • Phone: 269-471-8858
  • Fax:
Mailing address:
  • Phone: 517-748-6294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: