Provider Demographics
NPI:1902215049
Name:SAGGAU, MARY GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GRACE
Last Name:SAGGAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 LOUGHMOR PASS
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-0506
Mailing Address - Country:US
Mailing Address - Phone:314-974-7040
Mailing Address - Fax:
Practice Address - Street 1:623 LOUGHMOR PASS
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-0506
Practice Address - Country:US
Practice Address - Phone:314-974-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060069111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical