Provider Demographics
NPI:1518295252
Name:DANIEL, SARA N (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:N
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:N
Other - Last Name:RADKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1511 BARTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1901
Mailing Address - Country:US
Mailing Address - Phone:262-305-0711
Mailing Address - Fax:262-334-3588
Practice Address - Street 1:1511 BARTON AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1901
Practice Address - Country:US
Practice Address - Phone:262-305-0711
Practice Address - Fax:262-334-3588
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7052-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical