Provider Demographics
NPI:1578128633
Name:BUCKINGHAM, SARA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:BUCKINGHAM
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 1:2401 E 42ND AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5228
Mailing Address - Country:US
Mailing Address - Phone:907-744-1882
Mailing Address - Fax:
Practice Address - Street 1:2401 E 42ND AVE
Practice Address - Street 2:STE 306
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5228
Practice Address - Country:US
Practice Address - Phone:907-744-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical