Provider Demographics
NPI:1538997036
Name:SAGE, JESIKA LEIGH
Entity type:Individual
Prefix:
First Name:JESIKA
Middle Name:LEIGH
Last Name:SAGE
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 1:5354 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1471
Mailing Address - Country:US
Mailing Address - Phone:248-924-0510
Mailing Address - Fax:
Practice Address - Street 1:2080 UNION AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3247
Practice Address - Country:US
Practice Address - Phone:269-251-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator