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General NPI Number Information
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NPI Number | 1710487228
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Entity Type | Individual
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Provider Name | SARAH LACKNER
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Gender | Female
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 1050 29TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-3416
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Country | US
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Telephone | 541-926-4828
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Fax | 541-926-4891
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Provider Business Mailing Address
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Address Line | 43350 E BILYEU CREEK DR
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City | SCIO
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State | OR
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Zip | 97374-9335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | OR
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