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NPI Code Detail

MEDICARE: MR. SANDRA G PROCHAZKA LMSW

MEDICARE: MR. SANDRA G PROCHAZKA LMSW
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 Worker6801005822MI
2106H00000XMarriage & Family Therapist4101005601MI

General Provider Information

NPI Number : 1609933209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SANDRA G PROCHAZKA LMSW
Provider Business Mailing Address
First Line : 7950 JENNINGS RD
Second Line :
City : WHITMORE LAKE
State : MI
Zip : 48189-9511
Country : US
Telephone Number : 734-786-2364
Fax Number : 734-786-4915
Provider Business Practice Location Address
First Line : 3830 PACKARD ST STE 250
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-2273
Country : US
Telephone Number : 734-786-2364
Fax Number : 734-786-4915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 09/11/2025

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