Healthcare Provider Details

I. General information

NPI: 1164798203
Provider Name (Legal Business Name): SARA HAACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MAIN ST STE 240B
ANN ARBOR MI
48104-1929
US

IV. Provider business mailing address

2531 JACKSON AVE # 135
ANN ARBOR MI
48103-3818
US

V. Phone/Fax

Practice location:
  • Phone: 206-657-6213
  • Fax: 949-561-5371
Mailing address:
  • Phone: 206-657-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60485827
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301514583
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-19417
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: