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General NPI Number Information
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NPI Number | 1659506525
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH CROSS LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 2708 119TH AVE NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2912
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Country | US
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Telephone | 763-755-3801
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Fax | 763-755-1077
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Provider Business Mailing Address
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Address Line | 1711 COUNTY ROAD B W 320N
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City | ROSEVILLE
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State | MN
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Zip | 55113-4075
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Country | US
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Telephone | 651-528-8587
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Fax | 651-528-8541
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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 | 18010
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License Number State | MN
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