Healthcare Provider Details

I. General information

NPI: 1679057160
Provider Name (Legal Business Name): SARAH NICOLE NALLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HAMPTON AVE
SAINT LOUIS MO
63139-3138
US

IV. Provider business mailing address

1300 HAMPTON AVE STE 109
SAINT LOUIS MO
63139-3163
US

V. Phone/Fax

Practice location:
  • Phone: 314-374-1620
  • Fax:
Mailing address:
  • Phone: 314-374-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020007716
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: