Provider Demographics
NPI:1134615289
Name:KUBALL, SARAH MARIE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:KUBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 13TH AVE E STE A
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3328
Mailing Address - Country:US
Mailing Address - Phone:701-277-8844
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 425
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1808
Practice Address - Country:US
Practice Address - Phone:952-243-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
106S00000X
MN4763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician