Basic Information
Provider Information
NPI: 1093075566
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURNS
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LICSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9400 ZANE AVE N
Address2:  
City: BROOKLYN PARK
State: MN
PostalCode: 554431814
CountryCode: US
TelephoneNumber: 7637628800
FaxNumber: 7633154669
Practice Location
Address1: 6363 FRANCE AVE S STE 200
Address2:  
City: EDINA
State: MN
PostalCode: 554352140
CountryCode: US
TelephoneNumber: 9522309100
FaxNumber: 9529263103
Other Information
ProviderEnumerationDate: 05/18/2012
LastUpdateDate: 11/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X19755MNY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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