Provider Demographics
NPI:1922605823
Name:SAGE, DENA (MSW LICSW)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENA SAGE MSW, LICSW
Mailing Address - Street 1:317 WAYZATA BLVD E
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1683
Mailing Address - Country:US
Mailing Address - Phone:612-564-9104
Mailing Address - Fax:
Practice Address - Street 1:317 WAYZATA BLVD E
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1683
Practice Address - Country:US
Practice Address - Phone:612-564-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22309OtherSOCIAL WORK LICENSE