Healthcare Provider Details

I. General information

NPI: 1427305390
Provider Name (Legal Business Name): SARAH ELIZABETH ANDERSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W SUPERIOR ST SUITE 200
DULUTH MN
55802-3000
US

IV. Provider business mailing address

104 W SUPERIOR ST SUITE 200
DULUTH MN
55802-3000
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-7353
  • Fax: 218-727-2646
Mailing address:
  • Phone: 218-727-7353
  • Fax: 218-727-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2542
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: