Provider Demographics
NPI:1093936528
Name:KALLEN, SARA JANET (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANET
Last Name:KALLEN
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:MS
Other - First Name:SRAA
Other - Middle Name:JANET
Other - Last Name:KALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:30977 COUNTRY BLF
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1005
Mailing Address - Country:US
Mailing Address - Phone:248-661-5153
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-1005
Practice Address - Country:US
Practice Address - Phone:248-661-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist