Provider Demographics
NPI:1750904611
Name:SARA BOWERMAN, PH.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SARA BOWERMAN, PH.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BOWERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-992-4114
Mailing Address - Street 1:1558 DAUNTING DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7658
Mailing Address - Country:US
Mailing Address - Phone:916-939-7949
Mailing Address - Fax:916-467-7760
Practice Address - Street 1:5047 ROBERT J MATHEWS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5748
Practice Address - Country:US
Practice Address - Phone:916-992-4114
Practice Address - Fax:916-467-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty