Provider Demographics
NPI:1497179675
Name:STEPHAN, SARAH (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1849
Mailing Address - Country:US
Mailing Address - Phone:330-644-0699
Mailing Address - Fax:
Practice Address - Street 1:2910 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1849
Practice Address - Country:US
Practice Address - Phone:330-644-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3021971103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool