Provider Demographics
NPI:1699226316
Name:SROUFE, SARA (CLMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SROUFE
Suffix:
Gender:F
Credentials:CLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48804-0800
Mailing Address - Country:US
Mailing Address - Phone:989-773-6904
Mailing Address - Fax:989-772-5339
Practice Address - Street 1:107 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2503
Practice Address - Country:US
Practice Address - Phone:989-773-6904
Practice Address - Fax:989-772-5339
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010885161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical