Healthcare Provider Details

I. General information

NPI: 1225644131
Provider Name (Legal Business Name): SARATH PRIYA REDNAM-WALDO LMSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31600 TELEGRAPH RD STE 120
BINGHAM FARMS MI
48025-4370
US

IV. Provider business mailing address

31600 TELEGRAPH RD STE 120
BINGHAM FARMS MI
48025-4370
US

V. Phone/Fax

Practice location:
  • Phone: 314-805-4188
  • Fax:
Mailing address:
  • Phone: 248-579-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARATH P REDNAM-WALDO
Title or Position: OWNER
Credential: LMSW
Phone: 248-579-2772