Provider Demographics
NPI:1306557632
Name:MELLENDORF, SARAH (LLMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MELLENDORF
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 GRAND RIVER RD STE P
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9558
Mailing Address - Country:US
Mailing Address - Phone:810-225-9550
Mailing Address - Fax:810-225-9579
Practice Address - Street 1:10299 GRAND RIVER RD STE P
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9558
Practice Address - Country:US
Practice Address - Phone:810-225-9550
Practice Address - Fax:810-225-9579
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511155841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical