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Individual

SARAH SPEARS MATTINGLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CSW

Contact information

Practice address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 234-8572
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 234-8572

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
4903
KY
1041C0700X
Clinical Social Worker
Primary
4016
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000520921
ANTHEM
KY
05
30605018
KY
Enumeration date
03/12/2007
Last updated
03/20/2015
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