Provider Demographics
NPI:1518296599
Name:SACKETT, SARAH E (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:SACKETT
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 1:5500 NE 109TH CT
Mailing Address - Street 2:SUITE L
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6176
Mailing Address - Country:US
Mailing Address - Phone:360-828-5411
Mailing Address - Fax:
Practice Address - Street 1:5500 NE 109TH CT
Practice Address - Street 2:SUITE L
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6176
Practice Address - Country:US
Practice Address - Phone:360-828-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist