Healthcare Provider Details

I. General information

NPI: 1528756285
Provider Name (Legal Business Name): SARA JANE FIELDSON LCSW & LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 E COUNTY ROAD 66
WELLINGTON CO
80549-1734
US

IV. Provider business mailing address

5803 OLD LEGACY DR
FORT COLLINS CO
80528-9128
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-9803
  • Fax:
Mailing address:
  • Phone: 304-276-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002642
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933242
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: