Individual
DENA SAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW. LICSW
Contact information
Practice address
317 WAYZATA BLVD E, WAYZATA, MN 55391-1683
(612) 564-9104
Mailing address
317 WAYZATA BLVD E, WAYZATA, MN 55391-1683
(612) 564-9104
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
22309
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22309
SOCIAL WORK LICENSE
MN
Enumeration date
10/04/2020
Last updated
09/24/2024
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