Provider Demographics
NPI:1629128202
Name:TERWILLEGAR, SANDY (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:TERWILLEGAR
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-9502
Mailing Address - Country:US
Mailing Address - Phone:231-924-6920
Mailing Address - Fax:
Practice Address - Street 1:4845 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-9502
Practice Address - Country:US
Practice Address - Phone:231-924-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108976660OtherBCBSM