Provider Demographics
NPI:1669716072
Name:JAMES, SARA RENEE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RENEE
Last Name:JAMES
Suffix:
Gender:
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:R
Other - Last Name:KELLNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2504
Practice Address - Country:US
Practice Address - Phone:414-454-6500
Practice Address - Fax:414-454-6522
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI910-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100028190Medicaid