Provider Demographics
NPI:1629231485
Name:COZAD, SARA K (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:K
Last Name:COZAD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:K
Other - Last Name:STUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5638 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-5042
Mailing Address - Country:US
Mailing Address - Phone:317-247-8900
Mailing Address - Fax:317-247-8935
Practice Address - Street 1:5638 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5042
Practice Address - Country:US
Practice Address - Phone:317-247-8900
Practice Address - Fax:317-247-8935
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006168A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000705740OtherANTHEM BCBS
IN000000705740OtherANTHEM BCBS