Healthcare Provider Details

I. General information

NPI: 1093637639
Provider Name (Legal Business Name): SARA SELIGSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25139 SOUTHWOOD DR
SOUTHFIELD MI
48075-2062
US

IV. Provider business mailing address

25139 SOUTHWOOD DR
SOUTHFIELD MI
48075-2062
US

V. Phone/Fax

Practice location:
  • Phone: 248-837-0595
  • Fax:
Mailing address:
  • Phone: 248-837-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: