Provider Demographics
NPI:1275070385
Name:SIMMONS, SARAH DIANE (BA, BS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DIANE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BA, BS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DIANE
Other - Last Name:TIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, BS
Mailing Address - Street 1:1709 SW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2057
Mailing Address - Country:US
Mailing Address - Phone:206-714-5555
Mailing Address - Fax:
Practice Address - Street 1:1709 SW 112TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2057
Practice Address - Country:US
Practice Address - Phone:206-714-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor