Provider Demographics
NPI:1487211652
Name:MICKLATCHER, SARAH (LMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MICKLATCHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1373
Mailing Address - Country:US
Mailing Address - Phone:269-838-8727
Mailing Address - Fax:
Practice Address - Street 1:2450 44TH ST SE STE 302
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-259-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011138981041C0700X
MI6851104424104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical