Provider Demographics
NPI:1710234711
Name:ANDERSON-WILK, SARAH ALICE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ALICE
Last Name:ANDERSON-WILK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SW 6TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4323
Mailing Address - Country:US
Mailing Address - Phone:541-908-6121
Mailing Address - Fax:
Practice Address - Street 1:525 SW 6TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4323
Practice Address - Country:US
Practice Address - Phone:541-908-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL44471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical