MEDICARE: SARAH MELLENDORF LLMSW

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
1	1041C0700X	Clinical Social Worker	6851115584	MI

General Provider Information

NPI Number	:	1306557632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MELLENDORF LLMSW

Provider Business Mailing Address
First Line	:	10299 GRAND RIVER RD STE P
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-9558
Country	:	US
Telephone Number	:	810-225-9550
Fax Number	:	810-225-9579

Provider Business Practice Location Address
First Line	:	10299 GRAND RIVER RD STE P
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-9558
Country	:	US
Telephone Number	:	810-225-9550
Fax Number	:	810-225-9579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	11/06/2023

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