Provider Demographics
NPI:1265983621
Name:STRUCKMANN, SARA
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:STRUCKMANN
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 1:17A CEDAR HOUSE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-2436
Mailing Address - Country:US
Mailing Address - Phone:704-930-9625
Mailing Address - Fax:
Practice Address - Street 1:701 W UNION BLVD UNIT 8A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3732
Practice Address - Country:US
Practice Address - Phone:610-739-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional