Provider Demographics
NPI:1083374631
Name:ENGEN, SARAH (DCM, BCTMB)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ENGEN
Suffix:
Gender:F
Credentials:DCM, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SAINT CROIX ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1244
Mailing Address - Country:US
Mailing Address - Phone:651-329-7815
Mailing Address - Fax:
Practice Address - Street 1:3291 SAINT CROIX TRL S
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:MN
Practice Address - Zip Code:55001-9424
Practice Address - Country:US
Practice Address - Phone:651-300-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14524225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist