Healthcare Provider Details

I. General information

NPI: 1871407411
Provider Name (Legal Business Name): SARAH PHELPS-DIGMAN MSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 GREEN BAY RD STE 200
KENOSHA WI
53142-2931
US

IV. Provider business mailing address

5503 41ST AVE
KENOSHA WI
53144-3918
US

V. Phone/Fax

Practice location:
  • Phone: 262-864-1141
  • Fax:
Mailing address:
  • Phone: 262-287-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: