Provider Demographics
NPI:1659093482
Name:ROE, SARAH MICHAL
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHAL
Last Name:ROE
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 1:5632 S 94TH PLZ APT 3
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3437
Mailing Address - Country:US
Mailing Address - Phone:319-217-1499
Mailing Address - Fax:
Practice Address - Street 1:5632 S 94TH PLZ APT 3
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3437
Practice Address - Country:US
Practice Address - Phone:319-217-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health