Provider Demographics
NPI:1508545229
Name:GRIEBENOW, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GRIEBENOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2295 POND RD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:WI
Mailing Address - Zip Code:53059-9744
Mailing Address - Country:US
Mailing Address - Phone:262-391-7482
Mailing Address - Fax:
Practice Address - Street 1:W2295 POND RD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:WI
Practice Address - Zip Code:53059-9744
Practice Address - Country:US
Practice Address - Phone:262-391-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3001025110103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool