Provider Demographics
NPI:1093359424
Name:WATTS, SADIE ELIZABETH (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:ELIZABETH
Last Name:WATTS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 GREEN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1322
Mailing Address - Country:US
Mailing Address - Phone:507-649-1913
Mailing Address - Fax:
Practice Address - Street 1:625 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4219
Practice Address - Country:US
Practice Address - Phone:507-720-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN194021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty