Provider Demographics
NPI:1942211321
Name:BOOTH-SCHWADRON, SALLY G (CSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:G
Last Name:BOOTH-SCHWADRON
Suffix:
Gender:F
Credentials:CSW ACSW
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:G
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW CSW
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:734-426-8433
Practice Address - Street 1:6223 CANTON CTR RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-737-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801012399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker