Provider Demographics
NPI:1992035208
Name:SAGE, SARA (MS)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:DYKEHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1715 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3968
Mailing Address - Country:US
Mailing Address - Phone:574-214-4912
Mailing Address - Fax:574-226-0649
Practice Address - Street 1:1715 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3968
Practice Address - Country:US
Practice Address - Phone:574-214-4912
Practice Address - Fax:574-226-0649
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health