Healthcare Provider Details

I. General information

NPI: 1134577943
Provider Name (Legal Business Name): SARA RAUE PSY.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 13TH AVE
BELLE FOURCHE SD
57717-2404
US

IV. Provider business mailing address

2305 13TH AVE
BELLE FOURCHE SD
57717-2404
US

V. Phone/Fax

Practice location:
  • Phone: 605-723-3356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number77280-0
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: