Provider Demographics
NPI:1306364690
Name:PURDY, SALLY ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:PURDY
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 1:15860 GROVE RD.
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906
Mailing Address - Country:US
Mailing Address - Phone:517-974-3226
Mailing Address - Fax:
Practice Address - Street 1:3493 WOODS EDGE DR.
Practice Address - Street 2:SUITE #103
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-886-3707
Practice Address - Fax:517-349-1973
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010342831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical