1427483783 NPI number — SARAH LEANNE GANN LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427483783 NPI number — SARAH LEANNE GANN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANN
Provider First Name:
SARAH
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427483783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 JESS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALLISAW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-571-8710
Provider Business Mailing Address Fax Number:
479-452-5047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 N, WHEELER AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALLISAW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-775-5513
Provider Business Practice Location Address Fax Number:
918-775-5526
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  11023 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200766110 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com