Provider Demographics
NPI:1942718374
Name:RETERSTOFF, SARA L
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:RETERSTOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SORRENTO DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6623
Mailing Address - Country:US
Mailing Address - Phone:616-970-4172
Mailing Address - Fax:
Practice Address - Street 1:163 SORRENTO DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6623
Practice Address - Country:US
Practice Address - Phone:616-970-4172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106E00000X
MI1-21-54099103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst