Provider Demographics
NPI:1528394061
Name:PIKE, SARAH R (MA60114773)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:PIKE
Suffix:
Gender:F
Credentials:MA60114773
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 200TH ST SW APT 105
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6254
Mailing Address - Country:US
Mailing Address - Phone:206-931-8730
Mailing Address - Fax:
Practice Address - Street 1:5710 200TH ST SW APT 105
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6254
Practice Address - Country:US
Practice Address - Phone:206-931-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60114773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist