Provider Demographics
NPI:1548705478
Name:LAGRANGE, SARAH (PHD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:LAGRANGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1918 S HAWKSMOORE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7155
Mailing Address - Country:US
Mailing Address - Phone:812-599-0286
Mailing Address - Fax:
Practice Address - Street 1:1918 S HAWKSMOORE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7155
Practice Address - Country:US
Practice Address - Phone:812-599-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042999A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling