Provider Demographics
NPI:1083853394
Name:KENSMOE, SARA L (CSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:KENSMOE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E FIR ST
Mailing Address - Street 2:
Mailing Address - City:STRUM
Mailing Address - State:WI
Mailing Address - Zip Code:54770-7869
Mailing Address - Country:US
Mailing Address - Phone:715-695-3803
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST STE 1000
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3301
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:608-785-6315
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3454-120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator