Healthcare Provider Details

I. General information

NPI: 1558036806
Provider Name (Legal Business Name): SARAH JANE GARDNER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

5636 E DE BLAAY CT SE
KENTWOOD MI
49512-9511
US

V. Phone/Fax

Practice location:
  • Phone: 616-272-9423
  • Fax:
Mailing address:
  • Phone: 616-272-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119693
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: