Healthcare Provider Details

I. General information

NPI: 1548467822
Provider Name (Legal Business Name): SARAH KOLWEIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 S 40 DR
SAINT LOUIS MO
63141-8820
US

IV. Provider business mailing address

3638 SWEET BRIAR LANE
COLUMBIA IL
62236
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-7172
  • Fax: 341-692-8544
Mailing address:
  • Phone: 618-281-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: