MEDICARE: TAMARA SANDERS 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	104100000X	Social Worker	6801095703	MI

General Provider Information

NPI Number	:	1972906436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SANDERS LLMSW

Provider Business Mailing Address
First Line	:	443 N STATE ST
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1539
Country	:	US
Telephone Number	:	989-672-6160
Fax Number	:	989-672-5649

Provider Business Practice Location Address
First Line	:	624 W NEPESSING ST
Second Line	:	SUITE 300
City	:	LAPEER
State	:	MI
Zip	:	48446-2090
Country	:	US
Telephone Number	:	810-667-4500
Fax Number	:	810-667-4512

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/29/2014

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