Provider Demographics
NPI:1558021907
Name:OWNBEY, SARA KATHLEEN (ACSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATHLEEN
Last Name:OWNBEY
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:KATHLEEN
Other - Last Name:STUDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:429 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-7142
Mailing Address - Country:US
Mailing Address - Phone:209-747-7758
Mailing Address - Fax:
Practice Address - Street 1:1111 W TOKAY ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3850
Practice Address - Country:US
Practice Address - Phone:209-330-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1054151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical