Provider Demographics
NPI:1104562628
Name:EVANS, SARAH (PSYD, LP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 WOODDALE AVE S UNIT 12
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5166
Mailing Address - Country:US
Mailing Address - Phone:952-240-7362
Mailing Address - Fax:
Practice Address - Street 1:3712 WOODDALE AVE S UNIT 12
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55416-5166
Practice Address - Country:US
Practice Address - Phone:952-240-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty