Provider Information for 1447912480
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SARA N JETTAWI LPC
Other Names:Former Name:SARA SALZMAN LPCSex: Female
NPI: 1447912480
Last Updated: 2024-06-04
Certification Date: 2024-06-04
Certification Date: 2024-06-04
Details
| Name | Value | ||||||||||||||||
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| NPI | 1447912480 | ||||||||||||||||
| Enumeration Date | 2021-10-07 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 6233 39TH AVE KENOSHA, WI 53142-7015 United States Phone: 262-654-1004 | Fax: | ||||||||||||||||
| Primary Practice Address | 2108 63RD ST KENOSHA, WI 53143-4454 United States Phone: 262-652-2406 | Fax: | ||||||||||||||||
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