Healthcare Provider Details

I. General information

NPI: 1003480559
Provider Name (Legal Business Name): SARAH RENEE PUVALOWSKI MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36358 GARFIELD RD STE 2
CLINTON TOWNSHIP MI
48035-1152
US

IV. Provider business mailing address

36358 GARFIELD RD STE 2
CLINTON TOWNSHIP MI
48035-1152
US

V. Phone/Fax

Practice location:
  • Phone: 586-221-0705
  • Fax:
Mailing address:
  • Phone: 989-400-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: