Provider Demographics
NPI:1417520982
Name:HENDERSON, SAWYER ANN
Entity Type:Individual
Prefix:
First Name:SAWYER
Middle Name:ANN
Last Name:HENDERSON
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 1:1920 W CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5373
Mailing Address - Country:US
Mailing Address - Phone:714-687-6706
Mailing Address - Fax:
Practice Address - Street 1:1920 W CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5373
Practice Address - Country:US
Practice Address - Phone:714-687-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CA106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes172V00000XOther Service ProvidersCommunity Health Worker