Provider Demographics
NPI:1164215950
Name:SELVIUS, SARAH A
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:SELVIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 STONYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9553
Mailing Address - Country:US
Mailing Address - Phone:616-250-8247
Mailing Address - Fax:
Practice Address - Street 1:23800 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7710
Practice Address - Country:US
Practice Address - Phone:877-927-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician