Provider Demographics
NPI:1528819026
Name:FEDORSTON, SARAH CAMILLE
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CAMILLE
Last Name:FEDORSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CAMILLE
Other - Last Name:FEDORCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 W WONDERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-9102
Mailing Address - Country:US
Mailing Address - Phone:970-666-1601
Mailing Address - Fax:
Practice Address - Street 1:8623 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3317
Practice Address - Country:US
Practice Address - Phone:316-869-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021854101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional