Provider Demographics
NPI:1720269749
Name:ANDERSON, SARAH ELIZABETH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 2ND AVE W #104
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4165
Mailing Address - Country:US
Mailing Address - Phone:701-572-7650
Mailing Address - Fax:701-572-7656
Practice Address - Street 1:1135 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4165
Practice Address - Country:US
Practice Address - Phone:701-572-7650
Practice Address - Fax:701-572-7656
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4168104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1453283Medicaid