Provider Demographics
NPI:1083035141
Name:TAYLOR, SARAH
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9908 DUPONT LAKES DR
Mailing Address - Street 2:APT. 1A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-7346
Mailing Address - Country:US
Mailing Address - Phone:260-402-2696
Mailing Address - Fax:
Practice Address - Street 1:10315 DAWSONS CREEK BLVD
Practice Address - Street 2:E
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1912
Practice Address - Country:US
Practice Address - Phone:260-387-6984
Practice Address - Fax:260-387-6984
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health