Provider Demographics
NPI:1912546888
Name:PETKE, SARAH CHRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CHRISTINE
Last Name:PETKE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 NW NICOLAI ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2018
Mailing Address - Country:US
Mailing Address - Phone:971-801-0552
Mailing Address - Fax:
Practice Address - Street 1:2850 NW NICOLAI ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2018
Practice Address - Country:US
Practice Address - Phone:971-801-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional