Provider Demographics
NPI:1093963183
Name:DEWANE, SARAH L (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:DEWANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 BUSINESS PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7174
Mailing Address - Country:US
Mailing Address - Phone:907-743-7200
Mailing Address - Fax:907-743-7255
Practice Address - Street 1:4951 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7174
Practice Address - Country:US
Practice Address - Phone:907-743-7200
Practice Address - Fax:907-743-7255
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK624103T00000X
AK509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1608931Medicaid
AK624OtherALASKA STATE LICENSE