Individual
MRS. SALLY ANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, BCBA
Contact information
Practice address
5242 PLAINFIELD AVE NE STE A, GRAND RAPIDS, MI 49525-1084
(616) 363-2200
Mailing address
19 RADNY DR, LOWELL, MI 49331-9131
(616) 901-7180
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
1041C0700X
Clinical Social Worker
6801084828
MI
Other
Enumeration date
03/15/2021
Last updated
06/05/2024
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