Healthcare Provider Details

I. General information

NPI: 1376799452
Provider Name (Legal Business Name): SARAH KATE ROSENBLATT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W FLORIST AVE STE 125
GLENDALE WI
53209-3862
US

IV. Provider business mailing address

1720 W FLORIST AVE STE 125
GLENDALE WI
53209-3862
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-0801
  • Fax: 414-247-0816
Mailing address:
  • Phone: 414-247-0801
  • Fax: 414-247-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7271
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: