Provider Demographics
NPI:1811290034
Name:HALL-KENNEDY, SARA M
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:HALL-KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 S E ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4777
Mailing Address - Country:US
Mailing Address - Phone:707-571-5593
Mailing Address - Fax:
Practice Address - Street 1:144 S E ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4777
Practice Address - Country:US
Practice Address - Phone:707-571-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health