Healthcare Provider Details

I. General information

NPI: 1093305450
Provider Name (Legal Business Name): SARA STALLMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 37TH AVE S STE 200
MOORHEAD MN
56560-5524
US

IV. Provider business mailing address

815 37TH AVE S STE 200
MOORHEAD MN
56560-5524
US

V. Phone/Fax

Practice location:
  • Phone: 701-471-7092
  • Fax: 701-401-0267
Mailing address:
  • Phone: 701-471-7092
  • Fax: 701-401-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARA ANN STALLMAN
Title or Position: OWNER
Credential: LICSW, LCSW
Phone: 763-229-4995