Provider Demographics
NPI:1043018708
Name:PENDZISZEWSKI, SARAH LEEANN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LEEANN
Last Name:PENDZISZEWSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10179 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-7223
Mailing Address - Country:US
Mailing Address - Phone:269-615-5815
Mailing Address - Fax:
Practice Address - Street 1:2889 S 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2123
Practice Address - Country:US
Practice Address - Phone:269-343-1296
Practice Address - Fax:269-344-8485
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001131231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist