Most Relevant Information
Provider Data
| NPI Number: | 1003367186 |
| Provider Name: | SARA LOOSE LICSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 22844 |
Most Important Dates
| Enumeration Date: | 10/24/2016 |
| Last Updated: | 02/10/2021 |
Provider Practice Location
204 2ND ST NW
WASECA
MN
560932402
Practice Location Phone/Fax
| Phone: | 5078357064 |
| Fax: |
Provider Mailing Location
204 2ND ST NW
WASECA
MN
560932402
Provider Mailing Phone/Fax
| Phone: | 5078357064 |
| Fax: | 5078354870 |