Provider Demographics
NPI:1154465375
Name:SAYRE, JUDY LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LEIGH
Last Name:SAYRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 S CEDAR WIND LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-4237
Mailing Address - Country:US
Mailing Address - Phone:417-268-5060
Mailing Address - Fax:
Practice Address - Street 1:3668 S CEDAR WIND LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-4237
Practice Address - Country:US
Practice Address - Phone:417-268-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003251104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical