MEDICARE: SARAH ROSE DAVIS LBSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	06646	IA

General Provider Information

NPI Number	:	1639223027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ROSE DAVIS LBSW

Provider Business Mailing Address
First Line	:	1021 NEBRASKA STREET
Second Line	:	PO BOX 5410
City	:	SIOUX CITY
State	:	IA
Zip	:	51102-5410
Country	:	US
Telephone Number	:	712-252-2477
Fax Number	:	712-252-5516

Provider Business Practice Location Address
First Line	:	1021 NEBRASKA STREET
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51102-5410
Country	:	US
Telephone Number	:	712-252-2477
Fax Number	:	712-252-5516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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