Provider Demographics
NPI:1477392546
Name:MATUSZAK, SARA ELLEN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELLEN
Last Name:MATUSZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELLEN
Other - Last Name:HJALTADOTTIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 W CIVIC CENTER DR APT 137
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1224
Mailing Address - Country:US
Mailing Address - Phone:385-487-7160
Mailing Address - Fax:
Practice Address - Street 1:1283 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-5182
Practice Address - Country:US
Practice Address - Phone:435-649-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health