MEDICARE: SARAH P LAFOLLETTE

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	8266 -123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8266 -123	OTHER	WI	LICENSED CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1073949954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH P LAFOLLETTE

Provider Business Mailing Address
First Line	:	1720 W FLORIST AVE STE 125
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3862
Country	:	US
Telephone Number	:	414-247-0801
Fax Number	:	414-247-0816

Provider Business Practice Location Address
First Line	:	2266 N PROSPECT AVE STE 304
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-6306
Country	:	US
Telephone Number	:	414-247-0801
Fax Number	:	414-247-0816

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

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	03/06/2025

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Directions to “ SARAH P LAFOLLETTE ” Practice Location

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