Healthcare Provider Details

I. General information

NPI: 1205574506
Provider Name (Legal Business Name): SADIE BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 8TH ST S STE 200
MOORHEAD MN
56560-4200
US

IV. Provider business mailing address

2405 8TH ST S STE 200
MOORHEAD MN
56560-4200
US

V. Phone/Fax

Practice location:
  • Phone: 218-331-4866
  • Fax: 218-331-4867
Mailing address:
  • Phone: 218-331-4866
  • Fax: 218-331-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: