MEDICARE: MRS. MICHELE SANDERS LBSW

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	104100000X	Social Worker	6802074251	MI

General Provider Information

NPI Number	:	1760141154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE SANDERS LBSW

Provider Business Mailing Address
First Line	:	PO BOX 189
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-0189
Country	:	US
Telephone Number	:	517-592-1974
Fax Number	:	517-592-1975

Provider Business Practice Location Address
First Line	:	102 N MAIN ST
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8979
Country	:	US
Telephone Number	:	517-592-1974
Fax Number	:	517-592-1975

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

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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