Healthcare Provider Details

I. General information

NPI: 1598678971
Provider Name (Legal Business Name): SARAH MINDEDAHL LEACH RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 LIME ST STE 103
FERNANDINA BEACH FL
32034-4779
US

IV. Provider business mailing address

1701 SAN PABLO RD S APT 1515
JACKSONVILLE FL
32224-2804
US

V. Phone/Fax

Practice location:
  • Phone: 904-321-9145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW24007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: