Provider Demographics
NPI:1487991014
Name:FRANCIS, SARA NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:TABASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:217 WISCONSIN AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4946
Mailing Address - Country:US
Mailing Address - Phone:262-422-6763
Mailing Address - Fax:
Practice Address - Street 1:217 WISCONSIN AVE STE 211
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-422-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WI5572-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487991014Medicaid