Provider Demographics
NPI:1659506525
Name:CROSS, SARAH ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:CROSS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 COUNTY ROAD B W 320N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4075
Mailing Address - Country:US
Mailing Address - Phone:651-528-8587
Mailing Address - Fax:651-528-8541
Practice Address - Street 1:2708 119TH AVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2912
Practice Address - Country:US
Practice Address - Phone:763-755-3801
Practice Address - Fax:763-755-1077
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN180101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical