Individual
SARA ROSE RHODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC, ICS
Contact information
Practice address
571 COUNTY ROAD A, GREEN LAKE, WI 54941
(920) 294-4070
(920) 294-4139
Mailing address
571 COUNTY ROAD A, GREEN LAKE, WI 54941-8630
(920) 294-4070
(920) 294-4139
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12046-132
WI
1041C0700X
Clinical Social Worker
Primary
9169-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075650
—
WI
01
—
100080162
MEDICAID- CSAC
WI
01
—
15375-134
ICS STATE LICENSE
WI
Enumeration date
02/09/2018
Last updated
05/22/2019
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