Provider Demographics
NPI:1386316099
Name:BERNHARDT, SARAH JEAN (PSYS, NCSP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:BERNHARDT
Suffix:
Gender:F
Credentials:PSYS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3152
Mailing Address - Country:US
Mailing Address - Phone:701-321-2510
Mailing Address - Fax:
Practice Address - Street 1:16 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3152
Practice Address - Country:US
Practice Address - Phone:701-321-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1002951103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool