Provider Demographics
NPI:1831862788
Name:PLATH, SABRENA FAYRE (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:SABRENA
Middle Name:FAYRE
Last Name:PLATH
Suffix:
Gender:F
Credentials:LICSW, MSW
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31780 HILL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-7608
Mailing Address - Country:US
Mailing Address - Phone:507-696-3994
Mailing Address - Fax:
Practice Address - Street 1:124 TYLER RD S
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1733
Practice Address - Country:US
Practice Address - Phone:651-977-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN28953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health