Provider Demographics
NPI:1205589660
Name:BLACKBURN, SARAH (MA,, LMHC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MA,, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3403
Mailing Address - Country:US
Mailing Address - Phone:253-880-9800
Mailing Address - Fax:
Practice Address - Street 1:649 BELMONT CT
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3403
Practice Address - Country:US
Practice Address - Phone:253-880-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60882623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health