Healthcare Provider Details

I. General information

NPI: 1346880499
Provider Name (Legal Business Name): WILLIAM SAWYER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6053 HUDSON RD STE 250
WOODBURY MN
55125-1011
US

IV. Provider business mailing address

406 WACOUTA ST UNIT 216
SAINT PAUL MN
55101-2047
US

V. Phone/Fax

Practice location:
  • Phone: 651-410-7955
  • Fax:
Mailing address:
  • Phone: 612-597-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23549
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: