Healthcare Provider Details

I. General information

NPI: 1174932297
Provider Name (Legal Business Name): SARAH KATHLEEN RIMACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29500 SOUTHFIELD RD
SOUTHFIELD MI
48076-2030
US

IV. Provider business mailing address

6080 SOUTHWARD AVE
WATERFORD MI
48329-1436
US

V. Phone/Fax

Practice location:
  • Phone: 248-765-1795
  • Fax:
Mailing address:
  • Phone: 704-350-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: