Provider Demographics
NPI:1225107808
Name:SAWYER, STEVEN P (MSSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:P
Last Name:SAWYER
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10631
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-0631
Mailing Address - Country:US
Mailing Address - Phone:612-590-3190
Mailing Address - Fax:
Practice Address - Street 1:4505 WHITE BEAR PKWY
Practice Address - Street 2:SUITE 2200
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3678
Practice Address - Country:US
Practice Address - Phone:612-590-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003051041C0700X
MN3051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN754655000Medicaid