Sara Rose Rhode, LCSW, CSAC, ICS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9169-123 Issued in WI

Practice address

571 County Road a
Green Lake, WI 54941

Phone

(920) 294-4070

Fax

(920) 294-4139

NPI assigned

Feb 9, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1821597311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418630",
            "telephone_number": "920-294-4070",
            "fax_number": "920-294-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "54941",
            "telephone_number": "920-294-4070",
            "fax_number": "920-294-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RHODE",
        "first_name": "SARA",
        "middle_name": "ROSE",
        "credential": "LCSW, CSAC, ICS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9169-123",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "12046-132",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100075650",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICS STATE LICENSE",
            "identifier": "15375-134",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID- CSAC",
            "identifier": "100080162",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Nitz, SAC-IT
• Lauren Renee Olson
• Colleen Pomplun, DC
• Eric G Ratering, D.M.D.
• Danielle Marie Reysen, CCSH
• Lisa Ann Rollin, RN
• Sandra Schwoerer, MSN, FNP
• Wesley A Shemanski
• Abby Noel Vogt
• Nichol Wienkes

• All providers in Green Lake, WI
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.