Healthcare Provider Details

I. General information

NPI: 1780012765
Provider Name (Legal Business Name): SARAH KRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

PO BOX 772263
DETROIT MI
48277-2263
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801086287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: