Provider Demographics
NPI:1225354640
Name:HAZELWOOD, SARAH KATHRINE (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRINE
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33650 6TH AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6754
Mailing Address - Country:US
Mailing Address - Phone:253-942-3303
Mailing Address - Fax:
Practice Address - Street 1:33650 6TH AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6754
Practice Address - Country:US
Practice Address - Phone:253-942-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60141998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist