Provider Demographics
NPI:1619480571
Name:JAECK, SARAH MARIE (APSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:JAECK
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:5735 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5011
Mailing Address - Country:US
Mailing Address - Phone:262-598-1392
Mailing Address - Fax:
Practice Address - Street 1:5735 DURAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-5011
Practice Address - Country:US
Practice Address - Phone:262-598-1392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17770101YA0400X
WI130579104100000X
WI93061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker