Provider Demographics
NPI:1740614486
Name:DESSECKER, ABIGAIL SARAH (MSW)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:SARAH
Last Name:DESSECKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:SARAH
Other - Last Name:DULWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1200 N WEST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2174
Mailing Address - Country:US
Mailing Address - Phone:517-789-1234
Mailing Address - Fax:
Practice Address - Street 1:1200 N WEST AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2180
Practice Address - Country:US
Practice Address - Phone:517-789-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical