Provider Demographics
NPI:1225359797
Name:EYRE, SARA JEAN DREKE (LICSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN DREKE
Last Name:EYRE
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 1:1011 CALIFORNIA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3343
Mailing Address - Country:US
Mailing Address - Phone:651-334-6061
Mailing Address - Fax:
Practice Address - Street 1:1011 CALIFORNIA AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-3343
Practice Address - Country:US
Practice Address - Phone:651-334-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN167251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical