Provider Demographics
NPI:1053455329
Name:LILJA, SARAH (LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LILJA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 COUNTY ROAD D E STE A100
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5350
Mailing Address - Country:US
Mailing Address - Phone:651-592-1592
Mailing Address - Fax:651-429-2988
Practice Address - Street 1:2127 COUNTY ROAD D E STE A100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5350
Practice Address - Country:US
Practice Address - Phone:651-592-1592
Practice Address - Fax:651-429-2988
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1053455329Medicaid
MN547G6LIOtherBLUE CROSS OF MINNESOTA