MEDICARE: SARAH PATTISON 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	6851120658	MI

General Provider Information

NPI Number	:	1396605069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH PATTISON LLMSW

Provider Business Mailing Address
First Line	:	3351 CLAYSTONE ST SE STE G32
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5700
Country	:	US
Telephone Number	:	616-425-2412
Fax Number	:	616-828-4229

Provider Business Practice Location Address
First Line	:	3351 CLAYSTONE ST SE STE G32
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-5700
Country	:	US
Telephone Number	:	616-425-2412
Fax Number	:	616-828-4229

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

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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