Provider Demographics
NPI:1083851380
Name:RICHARDSON, SARAH KRISTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTIN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54173-8105
Mailing Address - Country:US
Mailing Address - Phone:303-408-1491
Mailing Address - Fax:
Practice Address - Street 1:976 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54173-8105
Practice Address - Country:US
Practice Address - Phone:303-408-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-1780101Y00000X, 1041C0700X
WI83411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor