Provider Demographics
NPI:1942988845
Name:BATER, SOPHIE ANNE
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ANNE
Last Name:BATER
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 1:19401 NORTHLINE RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2277
Mailing Address - Country:US
Mailing Address - Phone:734-785-7718
Mailing Address - Fax:
Practice Address - Street 1:19401 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2277
Practice Address - Country:US
Practice Address - Phone:734-785-7718
Practice Address - Fax:734-287-8221
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2025-02-11
Deactivation Date:2025-01-29
Deactivation Code:
Reactivation Date:2025-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator