Healthcare Provider Details

I. General information

NPI: 1881211829
Provider Name (Legal Business Name): SARAH JO CROSS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 GARRETT ST
FREDERICKTOWN MO
63645-1084
US

IV. Provider business mailing address

309 GARRETT ST
FREDERICKTOWN MO
63645-1084
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-4104
  • Fax: 573-783-4572
Mailing address:
  • Phone: 573-783-4104
  • Fax: 573-783-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2022025820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: