Provider Demographics
NPI:1396557492
Name:LONGENECKER, SARAH (CHC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LONGENECKER
Suffix:
Gender:F
Credentials:CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11958 W MILL RD APT 11
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1058
Mailing Address - Country:US
Mailing Address - Phone:812-457-4773
Mailing Address - Fax:
Practice Address - Street 1:11958 W MILL RD APT 11
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1058
Practice Address - Country:US
Practice Address - Phone:812-457-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 175T00000X
N430070171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist