Basic Information
| Provider Information | |||||||||
| NPI: | 1134610314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFFMAN | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63 | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486210063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897455666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 S CRAPO ST | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725938 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802089943 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.