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Provider Information for 1184955700


The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.

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TARRAH A GRADY LCSW


Other Names:  
Former Name: 
TARRAH HICKERSON LCSW

Sex: Female

NPI: 1184955700
Last Updated: 2024-08-27
Certification Date: 2024-08-27

Details

NameValue
NPI1184955700
Enumeration Date2010-01-21
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 2305 GEORGIA ST
LOUISIANA, MO 63353-2559
United States

Phone: 573-754-4584 | Fax:
 
Primary Practice Address 2305 GEORGIA ST
LOUISIANA, MO 63353-2559
United States

Phone: 573-754-4584 | Fax:
 
Secondary Practice Address(es)

1032 CROSSWINDS CT
WENTZVILLE, MO 63385-4836
United States

Phone: 844-853-8937 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Direct Messaging Address
thickerson@pike.cernerdirect.com
Pike County Memorial Hospital Direct Email Address
Direct CCDA 2305 Georgia St
Louisiana, MO 63353-2559
United States
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalMO2010001105