Provider Demographics
NPI:1740911239
Name:KIRKPATRICK, SARA (QMPH)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:QMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-8628
Mailing Address - Country:US
Mailing Address - Phone:217-358-0697
Mailing Address - Fax:
Practice Address - Street 1:1901 S 4TH ST STE 213
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4188
Practice Address - Country:US
Practice Address - Phone:217-358-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker