Provider Demographics
NPI:1881087971
Name:BOETTNER, SARAH (LPCC-S, LSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BOETTNER
Suffix:
Gender:F
Credentials:LPCC-S, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PENDLETON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-8819
Mailing Address - Country:US
Mailing Address - Phone:513-908-2722
Mailing Address - Fax:
Practice Address - Street 1:1110 PENDLETON ST STE 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8819
Practice Address - Country:US
Practice Address - Phone:513-908-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268540101YP2500X
OHS.0025551104100000X
OHE.1200022-S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker