Healthcare Provider Details

I. General information

NPI: 1396557492
Provider Name (Legal Business Name): SARAH LONGENECKER CHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11958 W MILL RD APT 11
MILWAUKEE WI
53225-1058
US

IV. Provider business mailing address

11958 W MILL RD APT 11
MILWAUKEE WI
53225-1058
US

V. Phone/Fax

Practice location:
  • Phone: 812-457-4773
  • Fax:
Mailing address:
  • Phone: 812-457-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberN430070
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: