Provider Demographics
NPI:1366547929
Name:BOERSMA, SARA J (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:J
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2547
Mailing Address - Country:US
Mailing Address - Phone:231-855-5511
Mailing Address - Fax:231-725-7241
Practice Address - Street 1:1576 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2547
Practice Address - Country:US
Practice Address - Phone:231-855-5511
Practice Address - Fax:231-725-7241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010803291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISB080329OtherBCBS PIN
MISB080329OtherBCBS PIN