Healthcare Provider Details

I. General information

NPI: 1245050293
Provider Name (Legal Business Name): SARA MARIE APPLEBEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E HIGHLAND DR
OCONTO FALLS WI
54154-1002
US

IV. Provider business mailing address

744 S WEBSTER AVE MEDICAL STAFF SERVICES
GREEN BAY WI
54301
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-0509
  • Fax: 920-846-0736
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8118-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: