Provider Demographics
NPI:1043858269
Name:KIDWELL, MORGAN SARA
Entity type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:SARA
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 STRATFORD WAY APT E
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-9182
Mailing Address - Country:US
Mailing Address - Phone:304-283-2812
Mailing Address - Fax:
Practice Address - Street 1:808 STRATFORD WAY APT E
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-9182
Practice Address - Country:US
Practice Address - Phone:304-283-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician