Provider Demographics
NPI:1144704396
Name:HALLER, SARAH ELISABETH (MA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISABETH
Last Name:HALLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELISABETH
Other - Last Name:SAGLIMBENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1565 LAKE JAMES DR
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9420
Mailing Address - Country:US
Mailing Address - Phone:989-538-0006
Mailing Address - Fax:
Practice Address - Street 1:630 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2527
Practice Address - Country:US
Practice Address - Phone:763-712-1903
Practice Address - Fax:763-712-1917
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101007212106H00000X
MN3346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty