Healthcare Provider Details

I. General information

NPI: 1568301604
Provider Name (Legal Business Name): SARAH ANNE BASHAM MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 BRITTAIN LN
SANTA ROSA CA
95401-5899
US

IV. Provider business mailing address

1387 VELMA AVE
SANTA ROSA CA
95403-7218
US

V. Phone/Fax

Practice location:
  • Phone: 707-525-8350
  • Fax:
Mailing address:
  • Phone: 707-542-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: