Provider Demographics
NPI:1508855586
Name:WERNER, SARA (MA, LP, RPT-S, SEP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:MA, LP, RPT-S, SEP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ZELLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4255 PHEASANT RIDGE DR NE STE 412
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5066
Mailing Address - Country:US
Mailing Address - Phone:763-703-3753
Mailing Address - Fax:763-703-3725
Practice Address - Street 1:4255 PHEASANT RIDGE DR NE STE 412
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5066
Practice Address - Country:US
Practice Address - Phone:763-703-3753
Practice Address - Fax:763-703-3753
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4967103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN336R1REOtherBCBS ID#
55042A006OtherTRIWEST/TRICARE
MN808194000OtherMAGELLAN/AETNA ID#
MNHP11294OtherHEALTH PARTNERS ID#