Provider Demographics
NPI:1114588563
Name:PETTRY, SARA C (BSW,LSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:PETTRY
Suffix:
Gender:F
Credentials:BSW,LSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:PICKENPAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2845 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1720
Mailing Address - Country:US
Mailing Address - Phone:740-454-9766
Mailing Address - Fax:740-588-6452
Practice Address - Street 1:2845 BELL ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1720
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357597Medicaid