Provider Demographics
NPI:1063829125
Name:GAUTREAUX, SARAH SELF (MSW, LICSWA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SELF
Last Name:GAUTREAUX
Suffix:
Gender:F
Credentials:MSW, LICSWA
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:ROBERT
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2922 RUDDELL RD SE APT 29
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7810
Mailing Address - Country:US
Mailing Address - Phone:337-315-1430
Mailing Address - Fax:
Practice Address - Street 1:612 WOODLAND SQUARE LOOP SE STE 401
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-754-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker