Provider Demographics
NPI:1215477542
Name:ALLEE-JATTA, SARA JANE (CSAC, CSIT, SAP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:ALLEE-JATTA
Suffix:
Gender:F
Credentials:CSAC, CSIT, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3700
Mailing Address - Country:US
Mailing Address - Phone:646-750-5416
Mailing Address - Fax:
Practice Address - Street 1:1955 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-3700
Practice Address - Country:US
Practice Address - Phone:646-750-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16292-132101YA0400X, 101YA0400X
IL34551101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100076669Medicaid