Provider Demographics
NPI:1861008559
Name:WILSON, SARAH GENEVIEVE
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GENEVIEVE
Last Name:WILSON
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 1:484 DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2228
Mailing Address - Country:US
Mailing Address - Phone:513-213-8899
Mailing Address - Fax:
Practice Address - Street 1:1099 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4329
Practice Address - Country:US
Practice Address - Phone:513-213-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child