Provider Demographics
NPI:1912559543
Name:COUCH, SARA ANN
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 UNIVERSITY PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1448
Mailing Address - Country:US
Mailing Address - Phone:760-289-2008
Mailing Address - Fax:
Practice Address - Street 1:111 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1471
Practice Address - Country:US
Practice Address - Phone:760-289-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program