Healthcare Provider Details

I. General information

NPI: 1215427356
Provider Name (Legal Business Name): KARRI MARIE SACKRIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARRI MARIE CAMPBELL

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39465 W 14 MILE RD
NOVI MI
48377-1600
US

IV. Provider business mailing address

39465 W 14 MILE RD
NOVI MI
48377-1600
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax: 888-483-0118
Mailing address:
  • Phone: 877-906-9699
  • Fax: 888-483-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117120
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: