Healthcare Provider Details

I. General information

NPI: 1740802230
Provider Name (Legal Business Name): SARAH ANGELICA SCHMIDT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANGELICA MYERS

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 COUNTY ROAD NN
ELKHORN WI
53121
US

IV. Provider business mailing address

PO BOX 1005
ELKHORN WI
53121-1005
US

V. Phone/Fax

Practice location:
  • Phone: 262-741-3200
  • Fax: 262-741-3217
Mailing address:
  • Phone: 262-741-3200
  • Fax: 262-741-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10046-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: