Provider Demographics
NPI:1770753766
Name:DE GRAVE, SARA L (MS, LPC, CSAC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:DE GRAVE
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:SZOLWINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2343 N 116TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1109
Mailing Address - Country:US
Mailing Address - Phone:414-614-3751
Mailing Address - Fax:
Practice Address - Street 1:17100 W NORTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4450
Practice Address - Country:US
Practice Address - Phone:262-786-9184
Practice Address - Fax:262-786-1906
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15661-132101YA0400X
WI4275-125101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional