Provider Demographics
NPI:1386858520
Name:GEE, SARA RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RENEE
Last Name:GEE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:RENEE
Other - Last Name:MAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-455-5000
Mailing Address - Fax:
Practice Address - Street 1:2118 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1425
Practice Address - Country:US
Practice Address - Phone:616-222-3720
Practice Address - Fax:616-222-3724
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085296104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16222153Medicare PIN