Provider Demographics
NPI:1982883104
Name:WISOTZKEY, SALLY (MSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:WISOTZKEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1580
Mailing Address - Country:US
Mailing Address - Phone:734-972-7534
Mailing Address - Fax:
Practice Address - Street 1:117 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1580
Practice Address - Country:US
Practice Address - Phone:734-972-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010348511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical