Provider Demographics
NPI:1497799506
Name:KIRKWOOD, SARA CATHERINE (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CATHERINE
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1530
Mailing Address - Country:US
Mailing Address - Phone:574-722-2443
Mailing Address - Fax:574-739-0520
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:STE 270
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1530
Practice Address - Country:US
Practice Address - Phone:574-722-4921
Practice Address - Fax:574-739-0520
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004044A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S85338Medicare UPIN
IN940670A8Medicare PIN
IN214730AMedicare ID - Type UnspecifiedMEDICARE ID