Provider Demographics
NPI:1275881880
Name:BERRY, SARA ELIZABETH (LISW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:BERRY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2771 OAKDALE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9747
Mailing Address - Country:US
Mailing Address - Phone:319-975-8705
Mailing Address - Fax:
Practice Address - Street 1:2771 OAKDALE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9747
Practice Address - Country:US
Practice Address - Phone:319-975-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007969104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker