Provider Demographics
NPI:1821568171
Name:SAGE, ANNETTE MARIE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:SAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:MARIE
Other - Last Name:RUGGLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 N WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1648
Mailing Address - Country:US
Mailing Address - Phone:989-513-3410
Mailing Address - Fax:
Practice Address - Street 1:501 N WAVERLY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1648
Practice Address - Country:US
Practice Address - Phone:989-513-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 156F00000X
MI156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst