Provider Demographics
NPI:1174058069
Name:BROCKES, SARAH LYNN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:BROCKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:KIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19815 95TH AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4105
Mailing Address - Country:US
Mailing Address - Phone:206-940-5417
Mailing Address - Fax:253-854-3666
Practice Address - Street 1:19815 95TH AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4105
Practice Address - Country:US
Practice Address - Phone:206-940-5417
Practice Address - Fax:253-854-3666
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL 60147129101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor