Provider Demographics
NPI:1851953103
Name:ROOS, SARA L
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:ROOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:NEWHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3955 S FARM ROAD 223
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3955 S. FARM ROAD 223
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742
Practice Address - Country:US
Practice Address - Phone:417-812-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2022-06-17
Deactivation Date:2019-09-05
Deactivation Code:
Reactivation Date:2020-04-03
Provider Licenses
StateLicense IDTaxonomies
IL180.009216101YP2500X
IL166.000944106H00000X
MO2014028181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist