Provider Demographics
NPI:1033519509
Name:HOTRUM, SARA (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HOTRUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 BYRD DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1567
Mailing Address - Country:US
Mailing Address - Phone:269-501-3020
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 1205
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3284
Practice Address - Country:US
Practice Address - Phone:269-241-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801104230104100000X
MI68010972771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801104230OtherSOCIAL WORK LICENSE