Provider Demographics
NPI:1073121133
Name:RUDEL, SARAH (LLMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUDEL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:VERHAEGHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 W WACKERLY ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2769
Mailing Address - Country:US
Mailing Address - Phone:989-832-2165
Mailing Address - Fax:
Practice Address - Street 1:720 W WACKERLY ST STE 11
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2769
Practice Address - Country:US
Practice Address - Phone:989-832-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011075191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical