Provider Demographics
NPI:1144760604
Name:FREDERICK, SARAH (MSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GULBRANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2600 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4828
Mailing Address - Country:US
Mailing Address - Phone:269-324-4141
Mailing Address - Fax:269-324-2020
Practice Address - Street 1:2600 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4828
Practice Address - Country:US
Practice Address - Phone:269-324-4141
Practice Address - Fax:269-324-2020
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010862451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical