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General NPI Number Information
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NPI Number | 1396522843
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Entity Type | Individual
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Provider Name | SARA ROUFS MPS, LADC
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Gender | Female
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 11671 FOUNTAINS DR STE 200
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4784
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Country | US
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Telephone | 612-488-5487
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 WAYZATA BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-1623
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306389
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License Number State | MN
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