Provider Demographics
NPI:1376658567
Name:KNIGHT, SARAH SPACIE (LISW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SPACIE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 JOHNSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-4865
Mailing Address - Country:US
Mailing Address - Phone:319-862-1688
Mailing Address - Fax:319-398-7006
Practice Address - Street 1:1540 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403
Practice Address - Country:US
Practice Address - Phone:319-862-1688
Practice Address - Fax:319-398-7006
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA009551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02502536Medicaid
IA23624OtherWELLMARK BCBS
IAI0973Medicare PIN