Provider Demographics
NPI:1609472588
Name:GEOGHEGAN, SARA DAVIDSON (APSW)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:DAVIDSON
Last Name:GEOGHEGAN
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N 2ND AVE W APT 1
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2540
Mailing Address - Country:US
Mailing Address - Phone:302-300-6615
Mailing Address - Fax:
Practice Address - Street 1:3215 TOWER AVE STE 108
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5328
Practice Address - Country:US
Practice Address - Phone:715-718-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009923100104100000X
WI19513875104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker