Provider Demographics
NPI:1316134216
Name:BANNON, SARAH BETH (MSW, LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BETH
Last Name:BANNON
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12951 CHARTREUSE DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7871
Mailing Address - Country:US
Mailing Address - Phone:517-669-5532
Mailing Address - Fax:517-669-5532
Practice Address - Street 1:12951 CHARTREUSE DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7871
Practice Address - Country:US
Practice Address - Phone:517-669-5532
Practice Address - Fax:517-669-5532
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010656031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical