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General NPI Number Information
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NPI Number | 1912204264
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Entity Type | Individual
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Provider Name | SARA ANN STALLMAN LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 815 37TH AVE S STE 200
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City | MOORHEAD
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State | MN
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Zip | 56560-5524
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Country | US
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Telephone | 701-471-7092
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Fax | 701-401-0267
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Provider Business Mailing Address
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Address Line | 815 37TH AVE S STE 200
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City | MOORHEAD
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State | MN
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Zip | 56560-5524
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Country | US
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Telephone | 701-471-7092
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Fax | 701-401-0267
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 5134
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18648
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License Number State | MN
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