Basic Information
| Provider Information | |||||||||
| NPI: | 1497799506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRKWOOD | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Credential: | MSW, LCSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 MICHIGAN AVENUE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | LOGANSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469471530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747222443 | ||||||||
| FaxNumber: | 5747390520 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 MICHIGAN AVE | ||||||||
| Address2: | STE 270 | ||||||||
| City: | LOGANSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469471530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5747224921 | ||||||||
| FaxNumber: | 5747390520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 10/01/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34004044A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.