Provider Demographics
NPI:1396359337
Name:MARTEN, SARAH LUETZOW (MSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LUETZOW
Last Name:MARTEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3428
Mailing Address - Country:US
Mailing Address - Phone:262-994-5662
Mailing Address - Fax:
Practice Address - Street 1:6441 ENTERPRISE LN STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1180
Practice Address - Country:US
Practice Address - Phone:608-400-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19209-130101YA0400X
WI131951-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)