Healthcare Provider Details

I. General information

NPI: 1336910322
Provider Name (Legal Business Name): SARAH ELIZABETH VAN DE MARK MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 POST RD
STEVENS POINT WI
54481-6132
US

IV. Provider business mailing address

2417 POST RD
STEVENS POINT WI
54481-6132
US

V. Phone/Fax

Practice location:
  • Phone: 715-544-6144
  • Fax: 715-544-4599
Mailing address:
  • Phone: 715-544-6144
  • Fax: 715-544-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12563-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: