Provider Demographics
NPI:1679034565
Name:LANNON, SARAH (MS, R-DMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LANNON
Suffix:
Gender:F
Credentials:MS, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2312
Mailing Address - Country:US
Mailing Address - Phone:413-348-4174
Mailing Address - Fax:
Practice Address - Street 1:2410 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4211
Practice Address - Country:US
Practice Address - Phone:510-278-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist