Provider Demographics
NPI:1336761105
Name:STIEFEL, SARAH ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:STIEFEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7018
Mailing Address - Country:US
Mailing Address - Phone:262-287-1999
Mailing Address - Fax:
Practice Address - Street 1:6032 40TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7018
Practice Address - Country:US
Practice Address - Phone:262-287-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131876-121104100000X
IL1490209721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker