Provider Demographics
NPI:1114578903
Name:LINDEMAN ROOT, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LINDEMAN ROOT
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 1:2300 ANITA LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8854
Mailing Address - Country:US
Mailing Address - Phone:501-388-2318
Mailing Address - Fax:
Practice Address - Street 1:1100 BOB COURTWAY DR STE 9
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4767
Practice Address - Country:US
Practice Address - Phone:501-812-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19-22AP-PL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR33775Medicaid