Provider Demographics
NPI:1841565249
Name:SACKRIDER, DANIELLE LYNN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LYNN
Last Name:SACKRIDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52260 N. NOTTAWA ROAD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MI
Mailing Address - Zip Code:49072-9707
Mailing Address - Country:US
Mailing Address - Phone:269-535-6263
Mailing Address - Fax:
Practice Address - Street 1:52262 NOTTAWA RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MI
Practice Address - Zip Code:49072-9707
Practice Address - Country:US
Practice Address - Phone:269-535-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010784431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical