Healthcare Provider Details

I. General information

NPI: 1104559293
Provider Name (Legal Business Name): SERRIA KATHLEEN SARRAZOLLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIERRA KATHLEEN SARRAZOLLA LCSW

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 W CHERRY LN STE 103
MERIDIAN ID
83642-1119
US

IV. Provider business mailing address

3313 W CHERRY LN STE 103
MERIDIAN ID
83642-1119
US

V. Phone/Fax

Practice location:
  • Phone: 360-610-5051
  • Fax:
Mailing address:
  • Phone: 360-610-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-43872
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-43872
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: