MEDICARE: MRS. SARA A TYLER LSCW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2007034423	MO

General Provider Information

NPI Number	:	1659729390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA A TYLER LSCW

Provider Business Mailing Address
First Line	:	1900 N PROVIDENCE RD STE 327
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3710
Country	:	US
Telephone Number	:	573-530-7953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N PROVIDENCE RD STE 327
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3710
Country	:	US
Telephone Number	:	573-530-7953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	03/14/2023

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