Provider Demographics
NPI:1164458600
Name:SHIPPY, SARAH B (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:B
Last Name:SHIPPY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DIVISION ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2095
Mailing Address - Country:US
Mailing Address - Phone:507-664-9407
Mailing Address - Fax:507-664-3862
Practice Address - Street 1:401 DIVISION ST S
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2095
Practice Address - Country:US
Practice Address - Phone:507-664-9407
Practice Address - Fax:507-664-3862
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health