Healthcare Provider Details

I. General information

NPI: 1376350330
Provider Name (Legal Business Name): SARAH LIEDL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH BRZOZOWSKI

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4997 COUNTY HIGHWAY F
CHIPPEWA FALLS WI
54729-5744
US

IV. Provider business mailing address

4997 COUNTY HIGHWAY F
CHIPPEWA FALLS WI
54729-5744
US

V. Phone/Fax

Practice location:
  • Phone: 715-559-9755
  • Fax:
Mailing address:
  • Phone: 715-559-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: