Provider Demographics
NPI:1417668542
Name:SAKSHAUG, VALKYRIE F
Entity Type:Individual
Prefix:
First Name:VALKYRIE
Middle Name:F
Last Name:SAKSHAUG
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 1:4322 RIDGE LN SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4291
Mailing Address - Country:US
Mailing Address - Phone:616-443-0956
Mailing Address - Fax:616-719-0386
Practice Address - Street 1:9371 WESTVIEW DR SE
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9324
Practice Address - Country:US
Practice Address - Phone:616-877-4131
Practice Address - Fax:616-877-4231
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS410415000320900000X
MIAS410414999320900000X
MIAS410414998320900000X
MIAF410290158320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities