# NORTHERN ROOTS THERAPY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598300972
- **Authorized official:** SARAH VINSON LCSW, SAL, CFRC (OWNER)
- **Authorized official phone:** (608) 400-3818

## Contact information

- **Practice address:** 2960 TRIVERTON PIKE DR, FITCHBURG, WI 53711-5896
- **Practice address phone:** (608) 234-1224
- **Mailing address:** 2960 TRIVERTON PIKE DR, FITCHBURG, WI 53711-5896
- **Mailing address phone:** (608) 234-1224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2019
- **Last updated:** 04/07/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100191303 | — | WI |