Provider Demographics
NPI:1568894699
Name:SAUER, SHANNON E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:E
Last Name:SAUER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 HOUGHTON ST
Mailing Address - Street 2:# 2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4010
Mailing Address - Country:US
Mailing Address - Phone:859-457-1117
Mailing Address - Fax:
Practice Address - Street 1:13 HOUGHTON ST
Practice Address - Street 2:# 2
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4010
Practice Address - Country:US
Practice Address - Phone:859-457-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical