Sara Wubben, LCSW
Individual provider Active NPI Clinical Social Worker · McCloud, CA
NPI 1851675326 · NPPES record last updated Aug 14, 2024
Key facts
- NPI
- 1851675326
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 80027 (CA)
- Practice address
- 116 W. Minnesota Avenue
McCloud, CA 96057-1143 - Phone
- (530) 964-2389
- NPI assigned
- Oct 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180223001861 | CA | Practitioner - Clinical Social Worker | 4082848684 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80027 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McCloud Healthcare Clinic, Inc. | Current |
Accepting new patients | |
| McCloud Healthcare Clinic, Inc. | Past | Accepting new patients |
Locations
4309 Stagecoach Rd
Dunsmuir, CA 96025
Phone (530) 235-2205
824 Pine St
Mount Shasta, CA 96067
Phone (530) 926-4528
Interoperability endpoints
- sara.wubben.1@25248.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L5849 | OR | |
| Clinical Social Worker | 1041C0700X | 80027 | CA | Yes |
Addresses
Primary practice location
116 W. Minnesota Avenue
McCloud, CA 96057-1143
Mailing address
PO Box 1143
McCloud, CA 96057-1143
Other practice location 1
140 S Holly St
Medford, OR 97501-3113
Phone (541) 774-8201
Other practice location 2
140 S Holly St
Medford, OR 97501-3113
Phone (541) 774-8201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851675326 | Medicaid | CA |
Other providers in McCloud, CA
- McCloud Healthcare Clinic, Inc.
- McCloud Union Elementary School
- Peak Medical Transportation
- Jeffrey Dean Ridge
- Heather R Smith
All providers in McCloud, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.