Provider Demographics
NPI:1821260241
Name:SPOONER, SARAH LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:SPOONER
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 1:100 E 19TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3395
Mailing Address - Country:US
Mailing Address - Phone:360-695-7334
Mailing Address - Fax:
Practice Address - Street 1:100 E 19TH ST
Practice Address - Street 2:STE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3395
Practice Address - Country:US
Practice Address - Phone:360-695-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist