Provider Demographics
NPI:1598840688
Name:MIZE, SARA JANE S (PHD)
Entity Type:Individual
Prefix:
First Name:SARA JANE
Middle Name:S
Last Name:MIZE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:SAARINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3989 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3900
Mailing Address - Country:US
Mailing Address - Phone:612-625-1500
Mailing Address - Fax:
Practice Address - Street 1:1300 S 2ND ST
Practice Address - Street 2:SUITE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1075
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3799103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN130519100Medicaid
MN61-90224OtherMEDICA CHOICE
MN1014760OtherPREFERRED ONE
MNHP48983OtherHEALTHPARTNERS
MNP00326504OtherRR MEDICARE
MN112536OtherUCARE
MNP00326504OtherRR MEDICARE