Provider Demographics
NPI:1366008856
Name:PETERSON, SARAH ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63480 PHOENIX WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8009
Mailing Address - Country:US
Mailing Address - Phone:541-480-1237
Mailing Address - Fax:541-623-2585
Practice Address - Street 1:147 SW SHEVLIN HIXON DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3185
Practice Address - Country:US
Practice Address - Phone:541-480-1237
Practice Address - Fax:541-623-2585
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty