Basic Information
| Provider Information | |||||||||
| NPI: | 1285944140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRECHTEL | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOGRASSO | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | GRACE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3165 MCKELVEY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142061614 | ||||||||
| FaxNumber: | 3142063399 | ||||||||
| Practice Location | |||||||||
| Address1: | 3165 MCKELVEY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142006463 | ||||||||
| FaxNumber: | 3142063992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2010 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 171M00000X | 2011002792 | MO | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.