Basic Information
Provider Information | |||||||||
NPI: | 1275914103 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KERR | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | DAWN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | AUD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STIFF | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: | D | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 843966 | ||||||||
Address2: |   | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641843966 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5738843300 | ||||||||
FaxNumber: | 5738840943 | ||||||||
Practice Location | |||||||||
Address1: | 525 N KEENE ST STE 201 | ||||||||
Address2: |   | ||||||||
City: | COLUMBIA | ||||||||
State: | MO | ||||||||
PostalCode: | 652016967 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5738824327 | ||||||||
FaxNumber: | 5738843316 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2015 | ||||||||
LastUpdateDate: | 09/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU 3059 | CA | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 231H00000X | A.02041 | OH | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 231H00000X | 2021024744 | MO | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   |
ID Information
ID | Type | State | Issuer | Description | 330097902 | 05 | MO |   | MEDICAID |