Provider Demographics
NPI:1770612913
Name:PAVEK, SARAH JO (MA,LP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JO
Last Name:PAVEK
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4587 BLAYLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1162
Mailing Address - Country:US
Mailing Address - Phone:651-470-3098
Mailing Address - Fax:
Practice Address - Street 1:5802 BLACKSHIRE PATH STE 221
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1618
Practice Address - Country:US
Practice Address - Phone:651-470-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3102103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent