Basic Information
| Provider Information | |||||||||
| NPI: | 1598069288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUTTER | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ANNNE | ||||||||
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| Credential: | SAC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 N OXFORD AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547035187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158341078 | ||||||||
| FaxNumber: | 7158341218 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 N OXFORD AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547035187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158341078 | ||||||||
| FaxNumber: | 7158341218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2011 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 15682 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.