Provider Demographics
NPI:1548661218
Name:HARRISON, SADIE
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:HARRISON
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 1:201 5TH ST NW
Mailing Address - Street 2:SUITE 790
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-7119
Mailing Address - Country:US
Mailing Address - Phone:701-444-3661
Mailing Address - Fax:
Practice Address - Street 1:201 5TH ST NW
Practice Address - Street 2:SUITE 790
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7119
Practice Address - Country:US
Practice Address - Phone:701-444-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2016-07-21
Deactivation Date:2014-11-19
Deactivation Code:
Reactivation Date:2016-07-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator