Healthcare Provider Details

I. General information

NPI: 1558021907
Provider Name (Legal Business Name): SARA KATHLEEN OWNBEY ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA KATHLEEN STUDT

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W TOKAY ST
LODI CA
95240-3850
US

IV. Provider business mailing address

429 CEDAR CT
LODI CA
95240-7142
US

V. Phone/Fax

Practice location:
  • Phone: 209-330-7155
  • Fax:
Mailing address:
  • Phone: 209-747-7758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW105415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: