Provider Demographics
NPI:1740816131
Name:CHRISTMAN, SARA KATHLEEN (PHD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHLEEN
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W SOUTH JORDAN PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5519
Mailing Address - Country:US
Mailing Address - Phone:018-302-3801
Mailing Address - Fax:
Practice Address - Street 1:1206 W SOUTH JORDAN PKWY STE D
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5519
Practice Address - Country:US
Practice Address - Phone:801-302-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11449191-2501103TC0700X
UT11449191-2504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist