Healthcare Provider Details

I. General information

NPI: 1568906493
Provider Name (Legal Business Name): SARAH LUKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MAIN AVE
TILLAMOOK OR
97141-3816
US

IV. Provider business mailing address

1270 DORIS RD
AUBURN HILLS MI
48326-2617
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-8201
  • Fax:
Mailing address:
  • Phone: 248-276-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101890
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL12654
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: