Provider Demographics
NPI:1356780027
Name:LUDOVIC, SARAH MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:LUDOVIC
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MICHELLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 16TH AVE N
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4058
Mailing Address - Country:US
Mailing Address - Phone:208-461-7149
Mailing Address - Fax:
Practice Address - Street 1:207 16TH AVE N
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-4058
Practice Address - Country:US
Practice Address - Phone:208-467-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-33046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker