Basic Information
| Provider Information | |||||||||
| NPI: | 1124651799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUDER | ||||||||
| FirstName: | KASEY | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8630 FLAT CREEK DR UNIT J | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493418950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899284367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 E BELTLINE AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495061214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168053660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2020 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401016410 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 6401018182 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.