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NPI Code Detail

MEDICARE: SARAH YVONNE TYRIA MSW

MEDICARE: SARAH YVONNE TYRIA MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerMI

General Provider Information

NPI Number : 1104505510
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH YVONNE TYRIA MSW
Provider Business Mailing Address
First Line : 1115 BALL AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-5904
Country : US
Telephone Number : 616-930-5409
Fax Number :
Provider Business Practice Location Address
First Line : 1115 BALL AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-5904
Country : US
Telephone Number : 616-930-5409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 12/10/2025

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