Provider Demographics
NPI:1003367186
Name:LOOSE, SARA (LICSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LOOSE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2402
Mailing Address - Country:US
Mailing Address - Phone:507-835-7064
Mailing Address - Fax:507-835-4870
Practice Address - Street 1:204 2ND ST NW
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2402
Practice Address - Country:US
Practice Address - Phone:507-835-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN228441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical