Provider Demographics
NPI:1962025833
Name:EVERGREEN, SARAH JANE (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:EVERGREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:BENKENDORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:5101 COLOGNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1316
Mailing Address - Country:US
Mailing Address - Phone:314-437-3402
Mailing Address - Fax:
Practice Address - Street 1:1295 BANDANA BLVD N STE 210
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5115
Practice Address - Country:US
Practice Address - Phone:888-272-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019020234104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker