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General NPI Number Information
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NPI Number | 1093359424
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Entity Type | Individual
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Provider Name | SADIE ELIZABETH WATTS MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 625 3RD AVE NW
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City | FARIBAULT
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State | MN
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Zip | 55021-4219
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Country | US
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Telephone | 507-720-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 735 GREEN MEADOW CT
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City | NORTHFIELD
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State | MN
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Zip | 55057-1322
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Country | US
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Telephone | 507-649-1913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19402
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License Number State | MN
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