Provider Demographics
NPI:1689830770
Name:KLUK, SANDRA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:KLUK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:24651 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3314
Mailing Address - Country:US
Mailing Address - Phone:586-791-5879
Mailing Address - Fax:
Practice Address - Street 1:900 COOK RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2713
Practice Address - Country:US
Practice Address - Phone:313-344-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010823901041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool