Provider Demographics
NPI:1639762461
Name:CUPP, SARAH M (APSW, LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:CUPP
Suffix:
Gender:F
Credentials:APSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-0029
Mailing Address - Country:US
Mailing Address - Phone:715-748-0251
Mailing Address - Fax:
Practice Address - Street 1:807 IMPALA DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1206
Practice Address - Country:US
Practice Address - Phone:715-748-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132094-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health