MEDICARE: MS. SARA B WILLERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	33336	TX

General Provider Information

NPI Number	:	1063610236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA B WILLERSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 140454
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-0454
Country	:	US
Telephone Number	:	214-596-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	8057 SHADY OAK DR
Second Line	:
City	:	AUBREY
State	:	TX
Zip	:	76227-8409
Country	:	US
Telephone Number	:	214-596-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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