Healthcare Provider Details

I. General information

NPI: 1245145531
Provider Name (Legal Business Name): SOPHIE WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E 3RD ST
ELK RAPIDS MI
49629-9402
US

IV. Provider business mailing address

220 W GARFIELD AVE
CHARLEVOIX MI
49720-1631
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-8991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851118874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: