Provider Demographics
NPI:1720443948
Name:GALLAGHER, SARAH (LISW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:IA
Mailing Address - Zip Code:52206-9741
Mailing Address - Country:US
Mailing Address - Phone:319-939-6508
Mailing Address - Fax:
Practice Address - Street 1:320 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-626-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker