Basic Information
| Provider Information | |||||||||
| NPI: | 1558833137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHATELAIN-GRESS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | PRISCILLA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BA, LSW, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 5TH ST S STE 105 | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565602768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182841800 | ||||||||
| FaxNumber: | 2182841801 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 5TH ST S STE 105 | ||||||||
| Address2: | |||||||||
| City: | MOORHEAD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565602768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182841800 | ||||||||
| FaxNumber: | 2182841801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2018 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 26974 | MN | N | Behavioral Health & Social Service Providers | Social Worker | 101YA0400X | 305693 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.