Healthcare Provider Details

I. General information

NPI: 1053911370
Provider Name (Legal Business Name): SARAH MARIE WHITMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT STE 205
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

212 TURTLE DR APT 210
FENTON MO
63026-5346
US

V. Phone/Fax

Practice location:
  • Phone: 636-300-9922
  • Fax:
Mailing address:
  • Phone: 314-680-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2020014105
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: