Healthcare Provider Details

I. General information

NPI: 1285105130
Provider Name (Legal Business Name): SANDRA DAWN FLURY-GARDNER MSCJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 08/03/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

40 E FERRY ST
DETROIT MI
48202-3802
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone: 734-785-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: