Basic Information
| Provider Information | |||||||||
| NPI: | 1083959977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONT | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | JANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2130 S PACIFIC HWY | ||||||||
| Address2: | |||||||||
| City: | TALENT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975406639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417786258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1545 HARBECK RD | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414762373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.