Provider Demographics
NPI:1942475942
Name:MODDE, SARAH R (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:R
Last Name:MODDE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 QUEENSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6709
Mailing Address - Country:US
Mailing Address - Phone:314-608-4882
Mailing Address - Fax:636-227-5726
Practice Address - Street 1:907 QUEENSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-6709
Practice Address - Country:US
Practice Address - Phone:314-608-4882
Practice Address - Fax:636-227-5726
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker