Provider Demographics
NPI:1265562755
Name:DHUSE, SARA REBECCA (PHD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:REBECCA
Last Name:DHUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 BURNING TREE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3833
Mailing Address - Country:US
Mailing Address - Phone:218-464-0908
Mailing Address - Fax:218-722-4400
Practice Address - Street 1:4815 BURNING TREE RD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3833
Practice Address - Country:US
Practice Address - Phone:218-464-0908
Practice Address - Fax:218-722-4400
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007217103TC0700X
MNLP5018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1265562755Medicaid
MN680002609Medicare PIN