Healthcare Provider Details

I. General information

NPI: 1689497968
Provider Name (Legal Business Name): SARAH SANDERS PHD, NCSP, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E NORTH DR
BLOOMINGTON IN
47401-6595
US

IV. Provider business mailing address

315 E NORTH DR
BLOOMINGTON IN
47401-6595
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-7700
  • Fax:
Mailing address:
  • Phone: 812-330-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043468A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1424928
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: