Provider Demographics
NPI:1649452194
Name:BLASZCZAK, SARAH MEGAN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MEGAN
Last Name:BLASZCZAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BOROF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2512 NW MARSHALL ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2882
Mailing Address - Country:US
Mailing Address - Phone:510-213-3389
Mailing Address - Fax:
Practice Address - Street 1:2512 NW MARSHALL ST APT 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2882
Practice Address - Country:US
Practice Address - Phone:510-213-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist