Provider Demographics
NPI:1679958078
Name:SAUCEDO, SARAH NICOLE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:SAUCEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CHRISTINA CT
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8045
Mailing Address - Country:US
Mailing Address - Phone:501-295-2628
Mailing Address - Fax:
Practice Address - Street 1:300 CHRISTINA CT
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8045
Practice Address - Country:US
Practice Address - Phone:501-295-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker