Provider Demographics
NPI:1659663987
Name:WIRKKALA, SARA K (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:K
Last Name:WIRKKALA
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 1:10 PIER 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-6318
Mailing Address - Country:US
Mailing Address - Phone:503-325-8438
Mailing Address - Fax:503-325-4402
Practice Address - Street 1:10 PIER 1 STE 101
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6318
Practice Address - Country:US
Practice Address - Phone:503-325-8438
Practice Address - Fax:503-325-4402
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL46071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical