Provider Demographics
NPI:1508426446
Name:EIDEN, SARAH ANDREA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANDREA
Last Name:EIDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2205
Mailing Address - Country:US
Mailing Address - Phone:785-432-1244
Mailing Address - Fax:
Practice Address - Street 1:1301 OAK ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3659
Practice Address - Country:US
Practice Address - Phone:785-628-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional