Provider Demographics
NPI:1699492371
Name:JEPPERSON, SARAH SUE (TCADC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SUE
Last Name:JEPPERSON
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:IA
Mailing Address - Zip Code:50658-9260
Mailing Address - Country:US
Mailing Address - Phone:641-229-0732
Mailing Address - Fax:
Practice Address - Street 1:703 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-2126
Practice Address - Country:US
Practice Address - Phone:641-228-1477
Practice Address - Fax:641-228-1468
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT22174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT22174Medicaid