Provider Demographics
NPI:1992018741
Name:SEDLACEK, BEVERLY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 COLFAX AVE.
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6753
Mailing Address - Country:US
Mailing Address - Phone:269-926-6199
Mailing Address - Fax:269-926-6780
Practice Address - Street 1:1850 COLFAX AVE.
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6753
Practice Address - Country:US
Practice Address - Phone:269-926-6199
Practice Address - Fax:269-926-6780
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276017101YM0800X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult