Provider Demographics
NPI:1104382571
Name:LOSINSKI, SARAH JO
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:LOSINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JO
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1127 SOUTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3655
Mailing Address - Country:US
Mailing Address - Phone:507-621-3177
Mailing Address - Fax:
Practice Address - Street 1:103 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3519
Practice Address - Country:US
Practice Address - Phone:507-345-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN37150OtherMEC2 LEGAL NONLICENSED PROVIDER