Healthcare Provider Details

I. General information

NPI: 1285944140
Provider Name (Legal Business Name): SARAH GRACE PRECHTEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH GRACE LOGRASSO LCSW

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MCKELVEY RD SUITE 200
BRIDGETON MO
63044-2550
US

IV. Provider business mailing address

3165 MCKELVEY RD SUITE 200
BRIDGETON MO
63044-2550
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-6463
  • Fax: 314-206-3992
Mailing address:
  • Phone: 314-206-1614
  • Fax: 314-206-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2011002792
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: