Provider Demographics
NPI:1528576238
Name:KIANI, SARAH KATHRYN CROMER (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KATHRYN CROMER
Last Name:KIANI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 SCHEFFER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1427
Mailing Address - Country:US
Mailing Address - Phone:319-610-5711
Mailing Address - Fax:
Practice Address - Street 1:1420 W DONALD ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1624
Practice Address - Country:US
Practice Address - Phone:319-232-4673
Practice Address - Fax:844-272-2253
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1114395258Medicaid