Healthcare Provider Details

I. General information

NPI: 1851675326
Provider Name (Legal Business Name): SARA WUBBEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W. MINNESOTA AVENUE
MCCLOUD CA
96057-1143
US

IV. Provider business mailing address

PO BOX 1143
MCCLOUD CA
96057-1143
US

V. Phone/Fax

Practice location:
  • Phone: 530-964-2389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5849
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: