Individual
DR. GALE SANDRA HACKWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
811 SHIP ST STE 4B, SAINT JOSEPH, MI 49085-1171
(269) 985-3618
(269) 609-6009
Mailing address
811 SHIP ST STE 4B, SAINT JOSEPH, MI 49085-1171
(269) 985-3618
(269) 609-6009
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301018315
MI
103TC0700X
Clinical Psychologist
Primary
6301018315
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699155226
GROUP NPI FOR LIGHTHOUSE BEHAVIORAL HEALTH
MI
Enumeration date
02/11/2020
Last updated
01/19/2021
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