Provider Demographics
NPI:1326913237
Name:BOULWARE, SARA (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BOULWARE
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCSP
Mailing Address - Street 1:211 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68784-5014
Mailing Address - Country:US
Mailing Address - Phone:402-287-2061
Mailing Address - Fax:
Practice Address - Street 1:3301 G ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3467
Practice Address - Country:US
Practice Address - Phone:402-494-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool