Healthcare Provider Details

I. General information

NPI: 1356829675
Provider Name (Legal Business Name): SARAH ZILLWEGER LPC (AZ), LPCC (CA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 03/15/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E SHEA BLVD STE 115
PHOENIX AZ
85028-3346
US

IV. Provider business mailing address

PO BOX 6452
PEORIA AZ
85385-6452
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-4383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC22873
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC13288
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC22873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: