MEDICARE: SARAH A DEACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	20601	MN

General Provider Information

NPI Number	:	1215557533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A DEACY

Provider Business Mailing Address
First Line	:	400 STINSON BLVD FL 2
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 LILAC DR N STE 151
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4536
Country	:	US
Telephone Number	:	763-525-1746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2026

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