Provider Demographics
NPI:1457087785
Name:DUCKSON, SARAH M (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:DUCKSON
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:KINDEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:486 VICTORIA ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3728
Mailing Address - Country:US
Mailing Address - Phone:195-269-3576
Mailing Address - Fax:
Practice Address - Street 1:486 VICTORIA ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3728
Practice Address - Country:US
Practice Address - Phone:952-693-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN291101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical