Provider Demographics
NPI:1629448287
Name:KIMMEL, SARAH (EDS, LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4554
Mailing Address - Country:US
Mailing Address - Phone:816-786-0638
Mailing Address - Fax:
Practice Address - Street 1:102 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-4554
Practice Address - Country:US
Practice Address - Phone:816-786-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038288172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker