Healthcare Provider Details

I. General information

NPI: 1629493978
Provider Name (Legal Business Name): SARAH TESS HANNAH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22170 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

IV. Provider business mailing address

22170 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

V. Phone/Fax

Practice location:
  • Phone: 248-372-6836
  • Fax: 248-355-1402
Mailing address:
  • Phone: 248-372-6836
  • Fax: 248-355-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091888
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: