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NPI Code Detail

MEDICARE: SARA LYNNE SUDA LCSW

MEDICARE: SARA LYNNE SUDA LCSW
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
11041C0700XClinical Social Worker5115ND

General Provider Information

NPI Number : 1447603832
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA LYNNE SUDA LCSW
Provider Business Mailing Address
First Line : 1615 17TH AVE S
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-5372
Country : US
Telephone Number : 701-795-8550
Fax Number :
Provider Business Practice Location Address
First Line : 1615 17TH AVE S
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-5372
Country : US
Telephone Number : 701-795-8550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2016
Last Update Date : 01/02/2026

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Directions to “ SARA LYNNE SUDA LCSW” Practice Location

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