MEDICARE: SARA ELIZABETH FRAUM LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178016916	IL

General Provider Information

NPI Number	:	1295304004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ELIZABETH FRAUM LPC

Provider Business Mailing Address
First Line	:	480 N MCCLURG CT
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 N MCCLURG CT
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4326
Country	:	US
Telephone Number	:	312-595-1787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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