Healthcare Provider Details

I. General information

NPI: 1730303199
Provider Name (Legal Business Name): SAMIE LEDYARD LLPC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57418 COUNTY ROAD 681
HARTFORD MI
49057-9421
US

IV. Provider business mailing address

5128 104TH AVE
GRAND JUNCTION MI
49056-9133
US

V. Phone/Fax

Practice location:
  • Phone: 269-621-3143
  • Fax: 269-621-2725
Mailing address:
  • Phone: 269-434-6379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401008424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: