Provider Demographics
NPI:1689718512
Name:BRACKENBURY, SARA (MSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:BRACKENBURY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:BRACKENBURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:514 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3459
Mailing Address - Country:US
Mailing Address - Phone:734-662-6300
Mailing Address - Fax:734-662-3365
Practice Address - Street 1:15 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2974
Practice Address - Country:US
Practice Address - Phone:734-662-6300
Practice Address - Fax:734-662-3365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker