Provider Demographics
NPI:1780426130
Name:POQUETTE, SARA FERN (APSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:FERN
Last Name:POQUETTE
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9829 N GOLF VILLA LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-7709
Mailing Address - Country:US
Mailing Address - Phone:218-940-3624
Mailing Address - Fax:
Practice Address - Street 1:10592 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6658
Practice Address - Country:US
Practice Address - Phone:715-934-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker