Provider Demographics
NPI:1821317405
Name:SARA ELLEN HASSELL
Entity Type:Organization
Organization Name:SARA ELLEN HASSELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CN, LD
Authorized Official - Phone:985-772-1551
Mailing Address - Street 1:13321 VENDETTA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7631
Mailing Address - Country:US
Mailing Address - Phone:985-772-1551
Mailing Address - Fax:502-241-2602
Practice Address - Street 1:13321 VENDETTA WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7631
Practice Address - Country:US
Practice Address - Phone:985-772-1551
Practice Address - Fax:502-241-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169345252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency