MEDICARE: SARAH MAGALLON LPC

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	101YP2500X	Professional Counselor	4248-226	WI

General Provider Information

NPI Number	:	1386117851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MAGALLON LPC

Provider Business Mailing Address
First Line	:	6525 GREEN BAY RD
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2967
Country	:	US
Telephone Number	:	262-789-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 GREEN BAY RD
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-2967
Country	:	US
Telephone Number	:	262-789-1191
Fax Number	:

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

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	08/19/2024

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