Provider Demographics
NPI:1841243870
Name:SAILER, MARY E
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:SAILER
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 1:3010 E STATE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4700
Mailing Address - Country:US
Mailing Address - Phone:260-471-0632
Mailing Address - Fax:260-471-3451
Practice Address - Street 1:3010 E STATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4700
Practice Address - Country:US
Practice Address - Phone:260-471-0632
Practice Address - Fax:260-471-3451
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14060ASO101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN448670OtherVALUE OPTIONS
IN000000006472OtherMPLAN
IN0000000182311OtherANTHME BCBS
IN1336OtherPHP
IN272066000OtherMAGELLAN
IN5816707OtherAETNA
IN18231OtherANTHEM HIP