Provider Demographics
NPI:1366473159
Name:HUBBARD, SARAH T (PH D)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:T
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 I ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3141
Mailing Address - Country:US
Mailing Address - Phone:443-864-3365
Mailing Address - Fax:
Practice Address - Street 1:4055 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2509
Practice Address - Country:US
Practice Address - Phone:443-864-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7994644-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB799Medicare ID - Type Unspecified
P39730Medicare UPIN