=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023438371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH E EHLERS (LCSW)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2014
-----------------------------------------------------
Last Update Date | 04/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1170 W. KANSAS AVE BLDG 10
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-200-1738
-----------------------------------------------------
Fax | 816-407-7706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3635 NE CYPRESS DR.
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-521-0479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2007020088
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------