Organization
SPROUTED SAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZI NAGUIB PSY.D. (CLINICAL DIRECTOR)
(734) 222-9277
Entity
Organization
Contact information
Practice address
300 N 5TH AVE STE 210, ANN ARBOR, MI 48104-1447
(734) 222-9277
Mailing address
300 N 5TH AVE STE 210, ANN ARBOR, MI 48104-1447
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12311188
CAQH ID
—
Enumeration date
05/14/2021
Last updated
05/14/2021
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