Healthcare Provider Details

I. General information

NPI: 1669905626
Provider Name (Legal Business Name): SARA LINDQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 03/13/2024
Certification Date:
Deactivation Date: 02/12/2024
Reactivation Date: 03/13/2024

III. Provider practice location address

668 3 MILE RD NW
GRAND RAPIDS MI
49544-8219
US

IV. Provider business mailing address

668 3 MILE RD NW
GRAND RAPIDS MI
49544
US

V. Phone/Fax

Practice location:
  • Phone: 616-649-3129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: