MEDICARE: SARA TODD 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	11081-123	WI
2	1041C0700X	Clinical Social Worker	256456	KY
3	1041C0700X	Clinical Social Worker	L7413	OR

General Provider Information

NPI Number	:	1982030011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA TODD LCSW

Provider Business Mailing Address
First Line	:	100 WILBURN RD STE 100
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1478
Country	:	US
Telephone Number	:	920-215-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 ATWOOD AVE STE 217
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5382
Country	:	US
Telephone Number	:	920-215-1254
Fax Number	:

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/09/2023

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