MEDICARE: SARA ANN EBSEN

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	103TS0200X	School Psychologist	469374	MN

General Provider Information

NPI Number	:	1598621419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ANN EBSEN

Provider Business Mailing Address
First Line	:	1221 ROSSMAN AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3899
Country	:	US
Telephone Number	:	218-847-9268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 ROSSMAN AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3899
Country	:	US
Telephone Number	:	218-847-9268
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ SARA ANN EBSEN ” Practice Location

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