Provider Demographics
NPI:1093322620
Name:LARSEN, SARAH KAY
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KAY
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 N SCHEURMANN RD APT 440
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-2220
Mailing Address - Country:US
Mailing Address - Phone:989-889-1822
Mailing Address - Fax:
Practice Address - Street 1:6296 BRIDGEPORT VILLAGE SQUARE DR STE 2
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9655
Practice Address - Country:US
Practice Address - Phone:989-401-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician