Provider Demographics
NPI:1720402035
Name:KUEHL, SHARA
Entity type:Individual
Prefix:MRS
First Name:SHARA
Middle Name:
Last Name:KUEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHARA
Other - Middle Name:
Other - Last Name:BARLAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:1221 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3463
Mailing Address - Country:US
Mailing Address - Phone:636-332-2959
Mailing Address - Fax:
Practice Address - Street 1:ONE CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-327-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO465707800Medicaid