Provider Demographics
NPI:1982054284
Name:HORDGES, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HORDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530638
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33747-0638
Mailing Address - Country:US
Mailing Address - Phone:646-894-8380
Mailing Address - Fax:
Practice Address - Street 1:550 N REO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1061
Practice Address - Country:US
Practice Address - Phone:813-374-2070
Practice Address - Fax:813-337-0937
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-43229103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst