Provider Demographics
NPI:1316762396
Name:CHEESMAN, SARAH (EDS)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:CHEESMAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2929
Mailing Address - Country:US
Mailing Address - Phone:812-462-4364
Mailing Address - Fax:812-462-4377
Practice Address - Street 1:501 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:WEST TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47885-1822
Practice Address - Country:US
Practice Address - Phone:812-462-4364
Practice Address - Fax:812-462-4377
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1567922103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool