Provider Demographics
NPI:1992694657
Name:LEININGER, SARAH MAYLIN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MAYLIN
Last Name:LEININGER
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11544 SW STATE ROUTE P
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MO
Mailing Address - Zip Code:64430-9179
Mailing Address - Country:US
Mailing Address - Phone:816-261-9789
Mailing Address - Fax:
Practice Address - Street 1:7514 GODDARD ST APT 102
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66214-1148
Practice Address - Country:US
Practice Address - Phone:816-261-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2631133V00000X
MO2021035230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered