Provider Demographics
NPI:1295405744
Name:BODENBACH, SADIE (CSAC)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:BODENBACH
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:ENDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 STROHMEYER DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1980
Mailing Address - Country:US
Mailing Address - Phone:920-722-2345
Mailing Address - Fax:
Practice Address - Street 1:607 W 7TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5923
Practice Address - Country:US
Practice Address - Phone:920-470-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16406-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)