Provider Demographics
NPI:1013762194
Name:LERCH, SARAH (EDS)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:LERCH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2464
Mailing Address - Country:US
Mailing Address - Phone:219-718-5700
Mailing Address - Fax:
Practice Address - Street 1:751 E PORTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9111
Practice Address - Country:US
Practice Address - Phone:219-786-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10167348103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool