Provider Demographics
NPI:1417691155
Name:MODEC, SARA RACHEL (LMFT)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:RACHEL
Last Name:MODEC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1645
Mailing Address - Country:US
Mailing Address - Phone:218-590-3366
Mailing Address - Fax:
Practice Address - Street 1:6015 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2538
Practice Address - Country:US
Practice Address - Phone:218-464-4448
Practice Address - Fax:218-464-4449
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist