Provider Demographics
NPI:1851036099
Name:JUPITER, SARA JO
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JO
Last Name:JUPITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-1922
Mailing Address - Country:US
Mailing Address - Phone:360-310-3137
Mailing Address - Fax:
Practice Address - Street 1:403 W STATE ST STE 206
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6140
Practice Address - Country:US
Practice Address - Phone:360-612-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health