Provider Demographics
NPI:1205666948
Name:LOPEZ MADDOX, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LOPEZ MADDOX
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3114
Mailing Address - Country:US
Mailing Address - Phone:781-605-9395
Mailing Address - Fax:
Practice Address - Street 1:118 N 35TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8654
Practice Address - Country:US
Practice Address - Phone:503-701-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician