Provider Demographics
NPI:1669709325
Name:SLAVICK, SARAH A (LCPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:SLAVICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3884 S MILL SITE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-8635
Mailing Address - Country:US
Mailing Address - Phone:563-528-9677
Mailing Address - Fax:
Practice Address - Street 1:1005 E PARK BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-7722
Practice Address - Country:US
Practice Address - Phone:563-528-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC5648101YM0800X
IL180007266101YM0800X
IA001025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health