Provider Demographics
NPI:1194546556
Name:EBNER, SARAH LUCILLE BOUDREAU (MA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LUCILLE BOUDREAU
Last Name:EBNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 MAYFIELD HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3612
Mailing Address - Country:US
Mailing Address - Phone:612-387-7960
Mailing Address - Fax:
Practice Address - Street 1:1155 CENTRE POINTE DR STE 8
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1278
Practice Address - Country:US
Practice Address - Phone:651-461-8033
Practice Address - Fax:651-461-8034
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional