Provider Demographics
NPI:1063976454
Name:SAGORSKI, ELAINA
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:SAGORSKI
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 1:5310 S PINE SLOPE CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9642
Mailing Address - Country:US
Mailing Address - Phone:616-263-7243
Mailing Address - Fax:
Practice Address - Street 1:5310 S PINE SLOPE CT SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9642
Practice Address - Country:US
Practice Address - Phone:616-263-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician