Provider Demographics
NPI:1467213637
Name:RUDD, SARAH M (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:RUDD
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 1:3310 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9231
Mailing Address - Country:US
Mailing Address - Phone:502-965-0000
Mailing Address - Fax:
Practice Address - Street 1:7510 DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258
Practice Address - Country:US
Practice Address - Phone:502-287-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2570531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical