Provider Demographics
NPI:1750477782
Name:LASKOWSKI, SARA JEAN (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JEAN
Last Name:LASKOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JEAN
Other - Last Name:KOBUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3900 W BROWN DEER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209
Mailing Address - Country:US
Mailing Address - Phone:414-540-2170
Mailing Address - Fax:414-540-2171
Practice Address - Street 1:3900 W BROWN DEER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209
Practice Address - Country:US
Practice Address - Phone:414-540-2170
Practice Address - Fax:414-540-2171
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI320126101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43595500Medicaid