Provider Demographics
NPI:1073993143
Name:COLE, SADIE H (PHD)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:H
Last Name:COLE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:MONAGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13129
Mailing Address - Street 2:1115 MAPLE WAY SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002
Mailing Address - Country:US
Mailing Address - Phone:215-880-0413
Mailing Address - Fax:
Practice Address - Street 1:1115 MAPLE WAY, SUITE D
Practice Address - Street 2:P.O. BOX 13129
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002
Practice Address - Country:US
Practice Address - Phone:215-880-0413
Practice Address - Fax:978-405-7019
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY631103TC0700X
MA10138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical