Provider Demographics
NPI:1114949229
Name:GUETZKOW, SARA HEITMAN (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HEITMAN
Last Name:GUETZKOW
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:HEITMAN
Other - Last Name:HAGGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19401 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2277
Mailing Address - Country:US
Mailing Address - Phone:734-785-7718
Mailing Address - Fax:734-287-8221
Practice Address - Street 1:19401 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2277
Practice Address - Country:US
Practice Address - Phone:734-785-7718
Practice Address - Fax:734-287-8221
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009640103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist