Provider Demographics
NPI:1902890494
Name:PENEGAR, SARAH WILLARD (PH D)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:WILLARD
Last Name:PENEGAR
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 WOODHILL PL
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6655
Mailing Address - Country:US
Mailing Address - Phone:865-691-5949
Mailing Address - Fax:865-523-2854
Practice Address - Street 1:3820 WOODHILL PL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6655
Practice Address - Country:US
Practice Address - Phone:865-691-5949
Practice Address - Fax:865-523-2854
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-904TN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN620944661-02OtherJOHN DEERE
TN005153OtherVALUE OPTIONS
TN3683781Medicaid
TN0025798OtherBL;UE CROSS/BLUE SHIELD O
TN0025798OtherBL;UE CROSS/BLUE SHIELD O
TN620944661-02OtherJOHN DEERE