Healthcare Provider Details

I. General information

NPI: 1770282097
Provider Name (Legal Business Name): SARAH VANSIPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 21 MILE RD
MACOMB MI
48044-2600
US

IV. Provider business mailing address

16700 21 MILE RD
MACOMB MI
48044-2600
US

V. Phone/Fax

Practice location:
  • Phone: 586-284-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152000199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: