MEDICARE: DENA SAGE MSW. LICSW

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	101YM0800X	Mental Health Counselor	22309	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22309	OTHER	MN	SOCIAL WORK LICENSE

General Provider Information

NPI Number	:	1922605823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA SAGE MSW. LICSW

Provider Business Mailing Address
First Line	:	317 WAYZATA BLVD E
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-1683
Country	:	US
Telephone Number	:	612-564-9104
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 WAYZATA BLVD E
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-1683
Country	:	US
Telephone Number	:	612-564-9104
Fax Number	:

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

Provider Enumeration Date	:	10/04/2020
Last Update Date	:	09/24/2024

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