Provider Demographics
NPI:1942696356
Name:BRANDENBERGER, SARAH E (MS, CGC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BRANDENBERGER
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3926 NEW VISION DR BLDG H
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:260-373-9728
Mailing Address - Fax:260-458-5636
Practice Address - Street 1:11115 PARKVIEW PLAZA DR
Practice Address - Street 2:ATTN: SARAH KING
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-266-8271
Practice Address - Fax:260-266-8271
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN74000081A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN123869OtherNATIONAL SOCIETY OF GENETIC COUNSELORS
IN74000081AOtherPROFESSIONAL LICENSING AGENCY OF INDIANA