Provider Demographics
NPI:1174761175
Name:MENNEN, SARA MICHELLE (MS, LMFT, RPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELLE
Last Name:MENNEN
Suffix:
Gender:F
Credentials:MS, LMFT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-0060
Mailing Address - Country:US
Mailing Address - Phone:507-934-6122
Mailing Address - Fax:507-934-2594
Practice Address - Street 1:1715 SHEPPARD DRIVE
Practice Address - Street 2:PO BOX 60
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-0060
Practice Address - Country:US
Practice Address - Phone:507-934-6122
Practice Address - Fax:507-934-2594
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist