Provider Demographics
NPI:1447580576
Name:LARSON, SARAH GOODRICH (CD,(DONA))
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GOODRICH
Last Name:LARSON
Suffix:
Gender:F
Credentials:CD,(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 NE QUIMBY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4140
Mailing Address - Country:US
Mailing Address - Phone:541-382-6273
Mailing Address - Fax:
Practice Address - Street 1:1032 NE QUIMBY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4140
Practice Address - Country:US
Practice Address - Phone:541-382-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR37400000X374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula