Provider Demographics
NPI:1841821477
Name:FREDRICH, SARAH J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:FREDRICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:408 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3806
Mailing Address - Country:US
Mailing Address - Phone:920-757-8407
Mailing Address - Fax:
Practice Address - Street 1:312 E MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3755
Practice Address - Country:US
Practice Address - Phone:920-215-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3139-1271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical