Provider Demographics
NPI:1457803116
Name:JUTRZONKA, SARAH (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JUTRZONKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EASTERN TRL
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1005
Mailing Address - Country:US
Mailing Address - Phone:262-366-5389
Mailing Address - Fax:
Practice Address - Street 1:1111 EASTERN TRL
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1005
Practice Address - Country:US
Practice Address - Phone:262-366-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical