Healthcare Provider Details

I. General information

NPI: 1164138780
Provider Name (Legal Business Name): SARAH J DRENNAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH J THOMPSON APSW

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 PROFESSIONAL DR
DODGEVILLE WI
53533-1176
US

IV. Provider business mailing address

1122 PROFESSIONAL DR
DODGEVILLE WI
53533-1176
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-2776
  • Fax: 608-935-3174
Mailing address:
  • Phone: 608-935-2776
  • Fax: 608-935-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123-10052
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: