Healthcare Provider Details

I. General information

NPI: 1740521558
Provider Name (Legal Business Name): SARAH ELLA GENE LANDERS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH ELLA GENE MARTIN MSW, LCSW

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 COUNTY ROAD 327
CAPE GIRARDEAU MO
63701-9395
US

IV. Provider business mailing address

628 COUNTY ROAD 327
CAPE GIRARDEAU MO
63701-9395
US

V. Phone/Fax

Practice location:
  • Phone: 573-518-7479
  • Fax: 573-733-6448
Mailing address:
  • Phone: 573-518-7479
  • Fax: 573-733-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2019023328
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: