Healthcare Provider Details

I. General information

NPI: 1013762194
Provider Name (Legal Business Name): SARAH LERCH ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E PORTER AVE STE 1
CHESTERTON IN
46304-9111
US

IV. Provider business mailing address

2266 LAKE ST
PORTAGE IN
46368-2464
US

V. Phone/Fax

Practice location:
  • Phone: 219-786-1582
  • Fax:
Mailing address:
  • Phone: 219-718-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10167348
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: