Healthcare Provider Details

I. General information

NPI: 1881087971
Provider Name (Legal Business Name): SARAH BOETTNER LPCC-S, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PENDLETON ST STE 2
CINCINNATI OH
45202-8819
US

IV. Provider business mailing address

1110 PENDLETON ST STE 2
CINCINNATI OH
45202-8819
US

V. Phone/Fax

Practice location:
  • Phone: 513-908-2722
  • Fax:
Mailing address:
  • Phone: 513-908-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number268540
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0025551
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1200022-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: