Healthcare Provider Details

I. General information

NPI: 1760353452
Provider Name (Legal Business Name): SARA EBNER PH.D.
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ERLANGER RD
ERLANGER KY
41018-1728
US

IV. Provider business mailing address

34 ERLANGER RD
ERLANGER KY
41018-1728
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-5782
  • Fax:
Mailing address:
  • Phone: 859-341-5782
  • Fax: 859-341-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number295414
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number295414
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: