Healthcare Provider Details

I. General information

NPI: 1740816131
Provider Name (Legal Business Name): SARA KATHLEEN CHRISTMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 08/27/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W SOUTH JORDAN PKWY STE D
SOUTH JORDAN UT
84095-5519
US

IV. Provider business mailing address

1206 W SOUTH JORDAN PKWY STE D
SOUTH JORDAN UT
84095-5519
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-3801
  • Fax:
Mailing address:
  • Phone: 18-302-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11449191-2504
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11449191-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: