Provider Demographics
NPI:1962299032
Name:RETZLAFF, SAYAKA
Entity type:Individual
Prefix:
First Name:SAYAKA
Middle Name:
Last Name:RETZLAFF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MARGARITA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2000
Mailing Address - Country:US
Mailing Address - Phone:805-215-9932
Mailing Address - Fax:
Practice Address - Street 1:210 MARGARITA AVE APT 5
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2000
Practice Address - Country:US
Practice Address - Phone:805-215-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)