Provider Demographics
NPI:1710300835
Name:PULLIAM, SARAH ALEXIS (LICSW, MPH)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ALEXIS
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:LICSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 N 200TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3149
Mailing Address - Country:US
Mailing Address - Phone:206-218-6618
Mailing Address - Fax:
Practice Address - Street 1:938 N 200TH ST STE E
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3149
Practice Address - Country:US
Practice Address - Phone:206-218-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical