Healthcare Provider Details

I. General information

NPI: 1447969845
Provider Name (Legal Business Name): SOPHIE SKOCHELAK LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 MOORSBRIDGE RD STE 102
PORTAGE MI
49024-4422
US

IV. Provider business mailing address

5591 N MAPLE RD
SALINE MI
48176-8758
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-6681
  • Fax:
Mailing address:
  • Phone: 734-545-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851108783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: