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General NPI Number Information
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NPI Number | 1417691155
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Entity Type | Individual
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Provider Name | SARA RACHEL MODEC LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 6015 E SUPERIOR ST
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City | DULUTH
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State | MN
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Zip | 55804-2538
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Country | US
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Telephone | 218-464-4448
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Fax | 218-464-4449
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Provider Business Mailing Address
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Address Line | 5131 ONEIDA ST
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City | DULUTH
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State | MN
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Zip | 55804-1645
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Country | US
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Telephone | 218-590-3366
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4294
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License Number State | MN
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