Provider Demographics
NPI:1801620372
Name:SARAH C KOENEN LISW LLC
Entity type:Organization
Organization Name:SARAH C KOENEN LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:KOENEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-971-1852
Mailing Address - Street 1:1603 22ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1410
Mailing Address - Country:US
Mailing Address - Phone:515-971-1852
Mailing Address - Fax:
Practice Address - Street 1:1603 22ND ST STE 203
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1410
Practice Address - Country:US
Practice Address - Phone:515-971-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty