Healthcare Provider Details

I. General information

NPI: 1144210014
Provider Name (Legal Business Name): SARAH A KLUENDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EVERSMAN DR
JASPER IN
47546-3548
US

IV. Provider business mailing address

10262 N OLD LAMAR HWY
LAMAR IN
47550-7426
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-3020
  • Fax: 812-482-6409
Mailing address:
  • Phone: 812-686-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004663A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: