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General NPI Number Information
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NPI Number | 1982330973
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Entity Type | Individual
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Provider Name | BEVERLY JOVON SADLER ICPR
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Gender | Female
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 408 TENNESSEE AVE
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City | CHARLESTON
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State | WV
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Zip | 25302-2338
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Country | US
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Telephone | 304-541-7243
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 VIRGINIA ST E APT A
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City | CHARLESTON
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State | WV
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Zip | 25311-2143
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Country | US
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Telephone | 304-541-7243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 21-936
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License Number State | WV
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