Healthcare Provider Details

I. General information

NPI: 1780138503
Provider Name (Legal Business Name): SARAH C HAZELWOOD LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 CASCADE RD SE
GRAND RAPIDS MI
49546-3700
US

IV. Provider business mailing address

1490 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4336
US

V. Phone/Fax

Practice location:
  • Phone: 616-929-0248
  • Fax:
Mailing address:
  • Phone: 616-940-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451020857
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: