Provider Demographics
NPI:1821575663
Name:FETTER, SARAH REBECCA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:REBECCA
Last Name:FETTER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:FETTER
Other - Last Name:ANTHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:2955 100TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5500
Mailing Address - Country:US
Mailing Address - Phone:515-400-0606
Mailing Address - Fax:515-405-4242
Practice Address - Street 1:2955 100TH ST STE 4
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-5500
Practice Address - Country:US
Practice Address - Phone:515-400-0606
Practice Address - Fax:515-405-4242
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091623103TH0100X
IA001289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service