MEDICARE: MRS. SARAH KAY CLINE L.C.S.W.

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	1041C0700X	Clinical Social Worker	149.014250	IL

General Provider Information

NPI Number	:	1588946669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH KAY CLINE L.C.S.W.

Provider Business Mailing Address
First Line	:	406 S PIERCE AVE
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-4635
Country	:	US
Telephone Number	:	630-205-3211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5133 WASHINGTON ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4788
Country	:	US
Telephone Number	:	630-205-3211
Fax Number	:

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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