Provider Demographics
NPI:1689436982
Name:DAENTL, SARAH (LPC-IT, ATR-P)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DAENTL
Suffix:
Gender:F
Credentials:LPC-IT, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S BEDFORD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3695
Mailing Address - Country:US
Mailing Address - Phone:608-313-4050
Mailing Address - Fax:
Practice Address - Street 1:301 S BEDFORD ST STE 7
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3695
Practice Address - Country:US
Practice Address - Phone:608-313-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-454221700000X
WI7477-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist