Provider Demographics
NPI:1851445902
Name:SHAW, SARAH (PHD, LP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13460 WALSH DR
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7529
Mailing Address - Country:US
Mailing Address - Phone:531-355-3362
Mailing Address - Fax:531-355-3375
Practice Address - Street 1:13460 WALSH DR
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7529
Practice Address - Country:US
Practice Address - Phone:531-355-3362
Practice Address - Fax:531-355-3375
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1053103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660631Medicaid