Provider Demographics
NPI:1730303199
Name:LEDYARD, SAMIE (LLPC, MA)
Entity Type:Individual
Prefix:
First Name:SAMIE
Middle Name:
Last Name:LEDYARD
Suffix:
Gender:F
Credentials:LLPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49056-9133
Mailing Address - Country:US
Mailing Address - Phone:269-434-6379
Mailing Address - Fax:
Practice Address - Street 1:57418 COUNTY ROAD 681
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-9421
Practice Address - Country:US
Practice Address - Phone:269-621-3143
Practice Address - Fax:269-621-2725
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)