Provider Demographics
NPI:1326321977
Name:MATLOCK, SARAH AMANDA (MSW, SWAICL)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:AMANDA
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:MSW, SWAICL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 17TH PL S
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1615
Mailing Address - Country:US
Mailing Address - Phone:206-766-6976
Mailing Address - Fax:206-766-6993
Practice Address - Street 1:10001 17TH PL S
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1615
Practice Address - Country:US
Practice Address - Phone:206-766-6993
Practice Address - Fax:206-766-6993
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602653501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical