Provider Demographics
NPI:1821106279
Name:SCHILPLIN, SARA ELVABOGESTAD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELVABOGESTAD
Last Name:SCHILPLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ELBA
Other - Last Name:BOGESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:12301 WHITEWATER DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9447
Mailing Address - Country:US
Mailing Address - Phone:952-999-6097
Mailing Address - Fax:952-426-0508
Practice Address - Street 1:12301 WHITEWATER DR
Practice Address - Street 2:STE 101
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9447
Practice Address - Country:US
Practice Address - Phone:952-999-6097
Practice Address - Fax:952-426-0508
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD491103TC0700X, 103TC2200X
MNLP4754103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2001653Medicaid
MN1821106279Medicaid
MN1821106279Medicaid
SDS104541Medicare PIN