Provider Demographics
NPI:1558833137
Name:CHATELAIN-GRESS, SARAH PRISCILLA (BA, LSW, LADC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:PRISCILLA
Last Name:CHATELAIN-GRESS
Suffix:
Gender:F
Credentials:BA, LSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 5TH ST S STE 105
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2768
Mailing Address - Country:US
Mailing Address - Phone:218-284-1800
Mailing Address - Fax:218-284-1801
Practice Address - Street 1:200 5TH ST S STE 105
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2768
Practice Address - Country:US
Practice Address - Phone:218-284-1800
Practice Address - Fax:218-284-1801
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26974104100000X
MN305693101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker