Provider Demographics
NPI:1477155323
Name:SANGER, MICHELE CAMPBELL
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:CAMPBELL
Last Name:SANGER
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 1:140 RADCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2935
Mailing Address - Country:US
Mailing Address - Phone:406-360-2252
Mailing Address - Fax:
Practice Address - Street 1:140 RADCLIFFE CT
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2935
Practice Address - Country:US
Practice Address - Phone:406-360-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL142071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical