Provider Demographics
NPI:1427626597
Name:SAUER, MARISSA ANNE (LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANNE
Last Name:SAUER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54106-0282
Mailing Address - Country:US
Mailing Address - Phone:920-570-2314
Mailing Address - Fax:
Practice Address - Street 1:1011 N LYNNDALE DR STE 2D
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3091
Practice Address - Country:US
Practice Address - Phone:920-385-1420
Practice Address - Fax:866-327-3295
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10633-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional