Healthcare Provider Details

I. General information

NPI: 1083112866
Provider Name (Legal Business Name): SARAH TAGERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 PRAIRIE CITY RD
FOLSOM CA
95630-9578
US

IV. Provider business mailing address

390 UNION BLVD STE 300
LAKEWOOD CO
80228-6514
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-1109
  • Fax: 916-683-1140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-25522
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: